Claims Processing

McKesson HealthQX value-based payment
By Bill Siwicki 01:11 pm July 12, 2016
McKesson expands its ability to support customers in bundled payment programs with HealthQX’s ClarityQx software.
CMS claims data

CMS Chief data Officer Niall Brennan said the new data will enable caregivers to make smarter clinical decisions.

By Bernie Monegain 10:48 am July 05, 2016
New rules under MACRA mean that qualified providers can share or sell analyses of Medicare and private claims data, which the Centers for Medicare and Medicaid Services could be a boon to better care delivery.

"Despite providers' best efforts to submit clean claims, a substantial number still get denied," says RelayHealth's Marcy Tatsch. "An effective denial prevention strategy doesn't just focus on pre-submission, but also on the other points along the claims continuum."

By Bernie Monegain 10:33 am June 27, 2016
Payers reject 6.4 percent of claims on the first go-round, company data show.
Epic EHR go-live revenue cycle ambulatory

St. Luke’s COO Joel Fagerstrom said that the implementation yielded operational and organizational results in just weeks. (Photo source: St. Luke's)

By Bernie Monegain 11:43 am May 27, 2016
While EHR implementations can be disruptive, the hospital system implemented new clinical and revenue cycle software in January and is pointing to its strategy of engaging every employee in the electronic health records system deployment.
Oracle Benefit Management ACA Affordable Care Act Value-based case

Enterprise software giant Oracle aligned with claims processing company Benefit Management to enable payers and providers to adopt new payment models. 

By Jack McCarthy 02:47 pm May 17, 2016
The platform will enable payments to be processed faster, reduce risk for hospitals transitioning to value-based care and ultimately decrease the cost of bundled procedures, the companies said. 
McKesson Trizetto ClaimsXten QNXT reimbursement
By Mike Miliard 11:04 am May 16, 2016
The collaboration aims to help health plans more easily scale both fee-for-service and value-based models.
By Jeff Lagasse 11:06 am May 02, 2016
The health system credits clinical and financial improvements to a CDI initiative that resulted in more accurate coding and greater physician engagement. 

With the fee-for-service business model changing to prospective payment and value-based care, healthcare organizations are undergoing a cultural shift that dramatically alters their approaches to patient intake, eligibility verification and claims processing.

By John Andrews 09:30 am April 20, 2016
Revenue cycle management has gone from being a "back office" function to an "end-to-end" system that begins at patient intake or even before, claims specialists say. Advanced technologies, in tandem with improved workflows and better data have resulted in RCM systems that encompass the entire healthcare enterprise.

Allyson Gilmore, principal data scientist at Ayasdi, said that understanding trends can help providers avoid losing money, but the data is complex. 

By John Andrews 10:12 am April 11, 2016
Advanced analytics and machine learning technologies are critical to pinpointing problems in large datasets that could be losing providers money. That’s why some organizations are investigating every single denied claim to better understand trends. 
By John Andrews 09:41 am April 11, 2016
Hospitals are starting to hire younger, more diverse people to handle the new coding. The shift will likely benefit healthcare organizations in time, but it won’t happen overnight.  

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