Claims Processing

Claims processing involves both healthcare payers and providers, and relies heavily on the use of IT systems to submit, receive and either approve or deny payment. Disrupted processing can subject providers to cost increases associated with inefficiency and outstanding balances. Hospital billing departments use billing and revenue cycle management systems to get claims processed and paid in the most timely and efficient manner possible.

RELATED STORIES: 
AMA calls on nation's health insurers to fix claims process
Emdeon acquires Chapin, better addressing hospital-based claims and payment recovery

 
AHIMA stands firm in plea for no ICD-10 delay
February 20, 2012 | Diana Manos
Officials at the American Health Information Management Association (AHIMA) said Friday they plan to urge the Department of Health and Human Services' (HHS) for no ICD-10 delay.
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ICD-10 inches closer to delay, ICD-11 in the wings
February 16, 2012 | Tom Sullivan
The case for leapfrogging ICD-10 and holding out for ICD-11 just got a lot more curious. And though it's not here yet, when ICD-11 is ready, it will be something ICD-10 cannot: A 21st Century classification system.
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CMS promise on ICD-10 stirs the pot
February 15, 2012 | Bernie Monegain
When acting CMS Administrator Marilyn Tavenner said Feb. 14 that CMS would take another look at the timeline for converting from the ICD-9 billing code set to ICD-10, she unleashed a barrage of response across the healthcare industry.
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Technology helps government recoup $4B in Medicare, Medicaid fraud
February 15, 2012 | Stephanie Bouchard
The efforts to curtail healthcare fraud have returned $4.1 billion to U.S. taxpayers in 2011, says a new report from the U.S. Department of Health and Human Services and the Department of Justice. The fraud-fighting techniques employed by the government are largely supported by new information technology.
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NaviNet to be acquired by Lumeris, Blues
February 14, 2012 | Chris Anderson
NaviNet, the real-time communication network for physicians, hospitals and payers, will be acquired by a group comprising three Blue health plans and health IT firm Lumeris.
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Blue KC goes for new master patient index
January 31, 2012 | Bernie Monegain
Blue Cross and Blue Shield of Kansas City will roll out a new enterprise master patient index that will enable the insurer to meet new demands for comprehensive, aggregated patient data in the health information exchange environment.
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Medicare cuts, ACOs to cause slowdown in diagnostic ECG device market
January 26, 2012 | Mike Miliard
A new report from Millennium Research Group shows that declining demand in private practices for diagnostic electrocardiography (ECG) devices will contribute to slow growth in the U.S. market -- despite a growing number of older patients who require the devices.
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Neupert to join Brailer's Health Evolution Partners
January 26, 2012 | Bernie Monegain
Former Microsoft Health Solutions Group executive Peter Neupert will join Health Evolution Partners, a venture capital firm launched by former National Coordinator for Health IT David Brailer, MD, as an operating partner.
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Buoyed by IT, small practice confidence is up
January 24, 2012 | Mike Miliard
Sixty percent of physicians in small or medium-sized practices say technology has made things easier for them, and nearly half say business is better this year compared to last, according to a new survey released today by EMR vendor Practice Fusion.


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South Carolina employs IT to boost Medicaid for kids
January 23, 2012 | Mary Mosquera
South Carolina has received kudos for improving improving how it expands and retains eligible children in Medicaid by using information from other safety-net programs, such as food stamps. The technology is employs to share data have also led to greater efficiency and reduced state administrative costs.
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States put tech to work on Medicaid enrollment
January 19, 2012 | Mary Mosquera
More than half of states expanded and simplified their Medicaid and Children's Health Insurance Programs' eligibility, enrollment and renewal procedures in 2011, often using technology to streamline and automate processes.
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HP, Blue Shield of California sign 5-year infrastructure deal
January 18, 2012 | Mike Miliard
HP Enterprise Services and Blue Shield of California have signed a five-year contract under which HP will provide technology infrastructure and applications support to the not-for-profit health plan, which has 3.3 million members.
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Payment Policy Optimization: Blending Analytics with Rules to Prevent Wasteful, Abusive and Fraudulent Healthcare Spending
December 12, 2011 | White Papers
Curtailing the massive drain caused by waste, abuse and fraud in healthcare has never been more impor¬tant. New payment models are on the horizon, including bundled payments, and greater emphasis is being placed on payment for outcomes. Given the magnitude and visibility of the problem, insurers need to avail themselves of advanced and effective means to reduce wasteful, abusive and fraudulent medical spend¬ing in the most efficient way possible. This demands a more holistic approach across the payment continuum, using technologies that not only address issues from multiple angles but also facilitate cross-organization partnership. Read more now.
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Accessing Medical Records on Mobile Devices
November 28, 2011 | White Papers
The emergence of a new class of Android (TM) mobile devices creates an opportunity for doctors and medical professionals to access patient data wherever they are. Read this white paper to learn how to access patient data and view medical images on Android devices.
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Cost Cutting Strategies for Improving the Delivery of Explanation of Benefits and Securing Health Information Exchange
September 18, 2011 | On Demand Webinars
This webinar will discuss cost-cutting strategies for securing sensitive patient communications, focusing on the delivery of Explanation of Benefits (EOBs), as well as other direct and portal-based electronic interactions that need to comply with HIPAA Privacy Rules.
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Reducing HAIs and Improving Infection Preventionist Workflow with Real-Time Clinical Surveillance
August 5, 2011 | On Demand Webinars
Please join us for an inside look into how with a clinical surveillance and reporting tool your facility can easily identify, manage and prevent healthcare-associated infections (HAIs).
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Care Episodes & Bundled Payment: Building and Automating Your Strategy
June 10, 2011 | White Papers
Hundreds of initiatives for care episodes are already underway in the U.S., relying on myriad combinations of provider types, legacy systems, and techniques. No single system on the market has the perfect solution across all areas. Bundling payments can reduce the cost of care by significantly reducing duplicative services, refocusing practice on collaboration across providers and rewarding quality outcomes. Learn more about automating major care process components by encompassing episode identification and definition as well as payment determination and timing.
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From Data to Decisions: Best Practices in Analytics for Payers
March 1, 2011 | On Demand Webinars
Learn how Fidelis Care simplified and accelerated their analytics environment, integrating claim data and other data sources for flexible, faster real-time reporting
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2012 is Coming: Prepare Your Compliance Processes for the Physician Payments Sunshine Act
February 28, 2011 | On Demand Webinars
Less than a year remains before aggregate-spend legislation becomes a reality throughout the healthcare industry. Beginning in 2012, pharmaceutical, biotechnology and medical products companies will be required to monitor promotional spending as never before. Join IBM and Healthcare IT News for a virtual tour of IBM's automated aggregate-spend compliance solution in action, including a live demonstration.
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Mitigating Risk Around HITECH and HIPAA
October 21, 2010 | On Demand Webinars
With all the recent regulatory changes from HITECH and HIPAA, what does it all mean to healthcare providers? Learn how to best assess the risk that these regulations pose to your IT environment. Hear from an industry peer about how their organization mitigated its risk, and learn more about how Symantec can better enable you to reduce your risk of becoming the next news headline.
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ICD-9 to ICD-10: Critical Success Factors to Complete a Transparent Transition
October 18, 2010 | On Demand Webinars
This webinar will focus on unfunded mandates and the healthcare reform impact on the U.S. healthcare industry. Our speaker will focus briefly on the HIPAA 4010 to 5010 conversion and discuss the ICD-9 to ICD-10 transition and the critical success factors payers need to accomplish to complete a transparent transition.
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HIMSS Leaders & Innovators excites C-suite execs 
November 22, 2011 | Mike Miliard
This past week I had the pleasure of traveling, along with MedTech Media Editorial Director Rich Pizzi, to Amelia Island, Fla. for the inaugural HIMSS Leaders & Innovators conference.
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Don't let customized applications snarl cash flow during ICD-10 conversion
March 1, 2011 | Scott Kelly
Most healthcare organizations have modified or customized their billing applications. While these customizations are fine for their intended purposes, they pose rather large obstacles to the ICD-10 code conversion process.
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Three more understated aspects of ICD-10, part two
August 6, 2010 | Tom Sullivan
ICD-10 is a multi-headed beast. As such, there are many faces to the new code sets; some are well known while others, often just as important, are not so understood.
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Top 5 HIPAA 5010, ICD-10 hurdles
April 8, 2010 | Tom Sullivan
It's no secret that the government mandated dynamic duo - that being HIPAA 5010 and ICD-10 - requires changes enormous in both number and scope. What's not as well understood is all the challenges they present.
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Updates on meaningful use, certified EHR technology and the stimulus bill
February 4, 2010 | Chris Thorman
In this table, we've combined the meaningful use objectives for both eligible professionals and hospitals for the Stage 1 adoption year, the required EHR technology criteria to accomplish those objectives and what criteria the government will use to measure meaningful use.
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Certification versus meaningful use
November 10, 2009 | John Halamka
Recently, clinicians have asked me "why should I implement my organization's preferred EHR when I've found a less expensive vendor that promises meaningful use?"
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Why Clinical Groupware May Be the Next Big Thing in Health IT
February 9, 2009 | David Kibbe
Clinical Groupware is a departure from the client-server and physician-centric EHR technology of the past 25 years, a fixed database technology that never really became popular.
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Harris Corporation Awarded $5.3 Million Contract to Integrate New Medical Coding Standards for U.S. Department of Veterans Affairs
October 27, 2011 | Industry News Release
he U.S. Department of Veterans Affairs (VA) has awarded Harris Corporation (NYSE:HRS), an international communications and information technology company, a $5.3 million contract to provide remediation to the VA’s Health Administration Center (HAC) Cache System to address new medical coding standards. This is a two-year contract with three optional tasks.
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DST Health Solutions introduces 360-degree member strategy with new integrated care management suite
September 13, 2011 | Industry News Release
DST Health Solutions, LLC, today introduced a new Integrated Care Management Suite of solutions that empowers health plans with flexible and comprehensive solutions to help reduce medical and administrative costs while improving clinical outcomes. Offering a 360-degree view of all members, the DST Health Solutions Integrated Care Management (ICM) Suite provides insight to properly manage populations, effectively utilize benefits and provide education for optimal self-management. The cornerstones of the ICM Suite are DSTHS CareAnalyzer® for member identification and CareConnect for care management. The ICM Suite leverages The Johns Hopkins Adjusted Clinical Groups (ACG) predictive model, which identifies members with the greatest opportunity to improve health outcomes, and identifies gaps in care.
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Optum Insight, InstaMed launch CareTracker Payment Connect
June 20, 2011 | Industry News Release
OptumInsight (formerly Ingenix) has collaborated with InstaMed, the leading Healthcare Payments Network, to offer CareTracker Payment Connect, a new feature for the CareTracker practice management system from OptumInsight, to help physicians give their patients more options to pay their bills electronically, and reduce administrative costs.
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23 percent of U.S. hospitals to invest in patient access solutions for eligibility
June 15, 2011 | Industry News Release
CapSite announces the release of the 2011 U.S. Patient Access Study. The study represents the latest in a series of CapSite strategic industry reports focused on the Revenue Cycle Management (RCM) market.
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Health 2.0, IMPAQ International and the NORC at the University of Chicago Announce a NEW Developer Challenge
June 2, 2011 | Industry News Release
Health 2.0, IMPAQ International (IMPAQ) and NORC at the University of Chicago (NORC) are proud to announce the launch of the Medicare Claims Data Developer Challenge, which will solicit entries to develop an online dashboard for comparative effectiveness, health services and health policy research.
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Geisinger boosts workflow with coding technology
May 25, 2011 | Industry News Release
Geisinger Health System, widely recognized for its implementation of innovative care models, is among the first healthcare organizations in the nation to deploy advanced technology that combines a Computer-Assisted Coding application with Natural Language Comprehension (NLC) in order to improve clinical documentation and coding accuracy.
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NEW AMA-MGMA ONLINE DIRECTORY HELPS PHYSICIANS SELECT PRACTICE MANAGEMENT SYSTEM SOFTWARE
April 28, 2011 | Industry News Release
Selecting the correct software to use in a medical practice is critical for physicians, particularly now that all technology-based practices must be compliant with the government's updated standard for electronic claims transactions. The new standard, known as HIPAA Version 5010, will be required by January 1, 2012. The American Medical Association (AMA) and the Medical Group Management Association (MGMA) have made the software selection process easier by developing an online directory of software vendors that helps physicians determine whether the vendors’ practice management systems are compliant with the 5010 standard. A companion piece to the recently released Selecting a Practice Management System toolkit, the Practice Management System Software Directory provides detailed vendor profiles, enabling physicians to easily choose the software that best fits their needs.
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Large Radiology Groups in the Northeast Turn to McKesson for Revenue Management
April 21, 2011 | Healthcare IT News Staff
Radiology & Imaging in Springfield, Mass., the largest radiology practice in Western Massachusetts, and Seacoast Radiology in Rochester, N.H., have joined other radiology practices in the Northeast using McKesson's Revenue Management Solutions (RMS) to optimize financial performance. With the industry’s most robust radiology billing and compliance solutions and extensive business intelligence capabilities, McKesson’s technology and services are designed to help the groups grow revenue, control costs and mitigate regulatory risks.
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