From Silos To Services For Value-Based Care

From Silos to Services for Value-Based Care

  • September 19, 2016

A bundled payment program built by hand 25 years ago is still delivering lessons for HIT today By Amy Larsson The evolution of healthcare IT systems seen by industry visionaries sounds great. Siloed clinical and insurance systems get connected and can work as one. Information-rich processes flow smoothly and securely over connected services that span care settings, providers, and payers. We gain leaps in efficiency, quality, and accuracy of care coordination, delivery, and payment systems. And as healthcare evolves in its journey to value, we snap clinical and payment services together like the related pieces of the healthcare puzzle that…

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The Interoperability Imperative

The Interoperability Imperative

  • September 19, 2016

How interoperability unlocks silos in enterprise applications and connects the business logic needed to support value-based reimbursement By Michael Wood Interoperability is about more than just moving data from one application to another. It’s about easily and seamlessly capitalizing on the business logic that is locked within separate—and often siloed—applications to create new capabilities that can solve business problems in a unique way. Today, interoperability must occur both within the four walls of a payer or provider’s IT infrastructure as well as within or between on-premise, off-premise, cloud, hybrid, and other hosting approaches in a manner that appears to be…

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Authorization Playing Catch Up With Technology

Authorization Playing Catch Up With Technology

  • September 1, 2016

For as much as healthcare has been transformed by technology, there are still areas where it seems to be a game of catch up—such as obtaining pre-service authorization. While patients are becoming more involved in their own care, providers are increasingly incentivized to secure authorization from payers before procedures are performed to increase their likelihood of receiving payment. According to a June 2016 survey by HealthLeaders Media, pre-authorization is a consistent pain point that impacts leaders from the C-suite to operations and billing. A total of 158 surveys were completed by the Media Council, which consists of senior, clinical, operations,…

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Fixing Healthcare’s Broken Pre-Authorization Screening & Verification Model

Fixing Healthcare’s Broken Pre-Authorization Screening & Verification Model

  • June 27, 2016

Among the processes that influence the healthcare revenue cycle, pre-authorization stands out—but not in a good way. It lacks the foundation of a widely-adopted electronic data exchange, resulting in repeated manual, ad hoc methods of securing and confirming payer approval for non-emergency medical services. And, all too often, there’s no centralized responsibility for obtaining pre-authorizations, with the necessary tasks scattered across even the most integrated of care delivery networks and, within those networks, even across various types of service. It’s time to take a closer look at the current state of pre-authorization and ways in which existing obstacles can be…

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Ten Steps To Reduce Denials, Win More  Appeals, And Improve Hospital Performance

Ten Steps to Reduce Denials, Win More Appeals, and Improve Hospital Performance

  • June 24, 2016

By Laura McIntire, R.N. Every day, someone at a health system or hospital asks me a variation on this question: How can I better manage denials? There’s tremendous pressure to reduce denials. According to CMS, 20% of all claims are denied, 60% of lost or denied claims will never be resubmitted, and 18% of claims will never be collected.1 Reworking each claim costs around $25.2 The problem is worsening as the complexity of claims processing intensifies. Our population is aging rapidly, and care needs are increasing. Medicare enrollment is rising. Comorbidities and chronic conditions are more prevalent. And population health…

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Journey To Value: The State Of Value-Based Reimbursement

Journey to Value: The State of Value-Based Reimbursement

  • June 13, 2016

There's no turning back from value-based care and value-based reimbursement. Payers are 58% along the continuum to VBR, up from 48% in 2014. And Providers are now 50% down the road to value. That's according to a national study of 465 payers and hospitals conducted by ORC International and commissioned by Change Healthcare. Yet despite tremendous growth in capitation/global payments, pay for performance, and episode of care/bundled payments, many payers and providers still face obstacles in the transition to value-based care. See where healthcare stands in its journey to value and what it means for the industry in Journey to Value: The…

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Short-Stay Inpatient Rate Is Zero? Time For Documentation Improvement

Short-Stay Inpatient Rate is Zero? Time for Documentation Improvement

  • May 11, 2016

Hospitals will need to reevaluate their documentation improvement programs because of revisions to the two-midnight rule, which allow for a case by case review of less-than-two-midnight stays. The quality improvement organizations have stated that the review will include InterQual screening criteria. Read the article

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Five Steps Payers Can Take To Make Provider Directories Accurate

Five Steps Payers Can Take to Make Provider Directories Accurate

  • April 14, 2016

It’s time to fix this problem and get it right as an industry. That might mean revising our business processes or rethinking the way we use technology. By Michael Flanagan Health plans that have been using quick fixes to update provider directories are facing an unwelcome wake-up call: fines that can range up to $25,000 per day per beneficiary. Moreover, payers found in violation of the Centers for Medicare & Medicaid Services (CMS) rules can be banned from new enrollment or marketing. These penalties are specific to Medicare Advantage programs and policies sold through Healthcare.gov, but they are emblematic of…

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The 4 KPIs You Need To Run A Successful Radiology Imaging Department

The 4 KPIs You Need to Run a Successful Radiology Imaging Department

  • March 3, 2016

By Jordan Lister, Senior Manager of Business Development, Change Healthcare Medical Imaging Professional Consulting Services You know that nagging feeling you get when you’ve forgotten something? Well, many medical imaging executives should be feeling that way. What have they forgotten? Important metrics. Yes, they’re measuring quality metrics like patient satisfaction, referring-physician satisfaction, and length of stay. They’ve carefully reviewed the recommendations from the Advisory Board and CMS’s PQRS program, and they’re religiously tracking their relative value units (RVUs). Nevertheless, they’re not measuring things that are vital to the success of their radiology imaging department. Why? Because healthcare has changed, and…

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Five Strategies For Maintaining Healthy Revenue During An EHR Transition

Five Strategies for Maintaining Healthy Revenue During an EHR Transition

  • February 29, 2016

You’ve heard the horror stories. Now hear how making clinical and financial data “inseparable” can help ensure a smooth migration that doesn’t blow up the revenue cycle. By Carmen Deguzman Sessoms Your EHR migration can cost you twice. But the second cost is avoidable if you know where to look and what to do. The first cost is obvious. It’s the cost of the migration itself, which, for hospitals, can run from under $10,000 to over $50,000 per physician, with ongoing monthly fees of $300 to $700 per doctor. For a large provider network, that can mean hundreds of millions…

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