Claims Processing

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.  
By John Andrews 08:18 am April 11, 2016
The healthcare industry appears to have successfully withstood the transition from ICD-9 to ICD-10. But are the sighs of relief premature? Is another shoe waiting to drop?
By Jeff Lagasse 04:42 pm March 31, 2016
The organization’s 2015 Index found that the U.S. is still spending unnecessary but significant sums of money on manual transactions when the technology is available to handle those electronically. 
John Freedman, MD, president of Freedman Healthcare, will lead a session intended to shed light on what APCDs are and where they’re headed in the future.
By Diana Manos 03:08 pm February 18, 2016
All but seven U.S. states have either passed or are working on legislation that would establish a state-sponsored, all-payer claims database – and that’s among the reasons these databases are in the spotlight for their promise to improve the way providers and insurance companies manage patient populations.
rcss site
By Healthcare Finance Staff 10:26 am December 08, 2015
As healthcare and technology professionals gather to share strategies for optimizing revenue cycle management in a challenging and fast-changing reimbursement environment, Healthcare IT News' sister publication Healthcare Finance offers live updates.
Magnifying glass on laptop
By Jessica Davis 09:44 am December 04, 2015
Triple-S Management Corporation has agreed to settle potential HIPAA violations with the U.S. Department of Health and Human services to the tune of $3.5 million, after repeatedly failing to put safeguards in place for its beneficiaries' PHI.

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