A country-wide sinkhole just opened under the healthcare landscape, at least that is the reporting from a MarketWatch.com article. The Republican Party’s triple win means “the worst possible outcome for [health care] stocks is a reality,” said Mizuho analyst Sheryl Skolnick, since eliminating the ACA would have tremendous implications across “virtually every sub-sector“ and “we have no idea what will replace it.” MarketWatch.com
The Healthcare Effectiveness Data and Information Set (HEDIS) is a tool used for health care performance measurement. Called the “Gold Standard” by the NCQA, HEDIS is used by 90% […]
The U.S. election looks to push a teetering ACA in any direction. The coming open enrollment periods will also influence the 2017 reactions from Health Plans and Providers. Gregory Scott, US Health Plans leader and vice chairman of Deloitte LLP (profile), shares his perspective on trends impacting health plans as they respond to the rise of consumerism and the proliferation of the value-based care model.
For a variety of reasons, some businesses choose employer-sponsored health plans instead of relying on commercial payers. The employer-payer relationship struggles in recent years because of a general lack of price transparency. This lack of price transparency continues pushing companies toward self-funding health plans.
New research shows that accountable care organizations are partnering with community resources and social service agencies to improve population health management according to a new report from Performance Evaluation: What Is Working In Accountable Care Organizations? Highlights from the study are presented here. Private payers and the alternative payment models they’ve used among accountable care organizations have shown mixed results, but coordinating with social service agencies may bring improvements in population health management. Coordination with community centers will take the hospital-centered approach to healthcare in a significantly and positive direction, the report states.
In April of 2016, CMS announced that a new type of tool to help consumers compare the breadth of plans’ networks on HealthCare.gov. A recent update to that announcement (September 2016) has notified the public that the roll out should start in 2017, for a small number of states.
Optimizing your revenue cycle starts with reducing denials. In order to do this, you must have an effective Denial Management strategy in place. According to a new HIMSS Analytics study, 56% of hospitals surveyed said they don’t use a vendor solution for claim denials. However, around 60% of those respondents are planning on purchasing a claims denials management tool within the next year. If you are part of the 40%, now may be the time to think about investing in tools for claims denials.
Health insurance claim denials could be causing your organization to lose a significant amount of revenue each year. An effective Denial Management strategy is one of the fastest ways to recoup lost revenue, and ensure that you are being paid for the care that you are providing. Studies indicate that approximately 25-30% of healthcare claims are rejected or denied. This results in millions of dollars of lost revenue each year. The majority of these losses can be avoided by implementing our unique denial management process.
Choosing the right Physician Advisor Services can be difficult. It’s important to look for a Physician Advisor Services that distinguishes itself through quality work, ongoing training, full compliance, and the latest technology. You want to trust the organization you choose and make sure they are industry certified.
The Centers for Medicare & Medicaid Services released the final version of its hospital quality ratings Wednesday and posted them to the Hospital Compare website. Many of the most well-known hospitals in the nation received below average scores while lesser known facilities took the top scores.