Reinventing Claims Management For The Value-Based Era

Reinventing Claims Management for the Value-Based Era

  • February 17, 2017

Provider claims management as we once knew it is not enough to thrive in a value-based era. Here’s what you need to know about taking claims management to a higher level. By Carmen Deguzman Sessoms Provider claims management can no longer exist as a silo. With the rapid transformation from fee-for-service to value-based models, denial rates remain high–nearly 1 in 5 claims–despite advances in technology and automation.1 The complexity of value-based payment models almost guarantees an increase in denials, simply because there’s so much to get wrong. For provider CFOs and their organizations to be effective–and thrive–in this environment, the…

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Getting In Front Of The Problem: How Can Hospitals Empower Denial Prevention And Management?

Getting in Front of the Problem: How Can Hospitals Empower Denial Prevention and Management?

  • November 22, 2015

Healthcare providers are chiefly concerned with two things: Ensuring patients receive the highest quality of care, and getting paid for that care. Despite advances in medical technology and a declining number of uninsured Americans, hospitals still experience difficulty getting paid fully and in a timely manner today. Hospital and health system CEOs have named financial challenges as their No. 1 concern every year from 2012 to 2014, according to the American College of Healthcare Executives.1 Claim denials are a significant contributor to these challenges. Denials are a pervasive and persistent problem, as up to 1 in 5 claims is delayed or…

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Five Ways To Improve Medi-Cal Claims Processing

Five Ways to Improve Medi-Cal Claims Processing

  • September 23, 2015

Roughly one in three California residents— approximately 12 million people—are enrolled in Medi-Cal, the state’s publicly funded Medicaid program. To put this in perspective, California has 12% of the U.S. population, and yet accounts for 17% of the nation’s Medicaid enrollment. And the enrollment is growing—with 2.7 million people added since federal healthcare reform was enacted. Given the large percentage of revenue that Medi-Cal claims constitute for California hospitals, efficient and accurate Medi-Cal claims processing is a high priority for healthcare providers. But in reality, many providers find that Medi-Cal claims can be difficult to manage. The root causes of…

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