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

 
N.Y. man defrauds Medicare of $70,000 in medical device reimbursements
May 15, 2012 | Diana Manos
A New York man pleaded guilty in district court this week for forging physician's chart notes to make Medicare or private carrier claims qualify for reimbursements for bone growth stimulator medical devices.
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Gateway EDI acquires NHXS
May 15, 2012 | Mike Miliard
TriZetto subsidiary Gateway EDI announced Tuesday its acquisition of Sacramento, Calif.-based NHXS, which develops software meant to help medical practices manage physician reimbursement and recover lost revenues.
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Boston Medical Center signs agreement with Streamline Health Solutions
May 14, 2012 | Diana Manos
Streamline Health Solutions, a developer of enterprise content management and business analytics software, announced Monday that Boston Medical Center has signed an additional five-year agreement to license the company's technology for use in its 19 physician group practices.
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CHIME supports year delay on ICD-10 as 'middle ground'
May 9, 2012 | Bernie Monegain
The College of Healthcare Information Management Executives (CHIME) on Wednesday submitted comments on ICD-10 proposed rulemaking to Health and Human Services Secretary Kathleen Sebelius. CHIME urged HHS to remain committed to ICD-10, while calling the one-year delay an appropriate "middle ground" for all stakeholders.
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AHIMA repeats opposition to ICD-10 delay
May 9, 2012 | Bernie Monegain
AHIMA has said it before, and it is saying it again. Delaying ICD-10 deadlines is not a good idea. However in a comment letter filed Wednesday with the Department of Health and Human Services, the organization said it would continue to work with HHS to ensure the delay would be as short as possible.
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New tenants sign on for Nashville Medical Trade Center
May 4, 2012 | Mike Miliard
The downtown Nashville Medical Trade Center on Friday announced a slate of health information technology companies, including Informatics Corporation of America and the SSI Group, as tenants.
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CMS rule targets Medicare fraud as GAO says more could be done
April 24, 2012 | Bernie Monegain
Even as the Centers for Medicare & Medicaid Services (CMS) announced a final rule Tuesday aimed at preventing Medicare fraud and saving taxpayers nearly $1.6 billion over 10 years, the GAO came out with a report urging CMS to do more.
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Li'l Rhody big on health IT
April 24, 2012 | Diana Manos
Rhode Island may be the smallest state in the U.S., but it packs a big punch when it comes to health IT.
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With ICD-10 looming, providers look to computer-assisted coding
April 23, 2012 | Bernie Monegain
As they prepare to convert to ICD-10, nearly half of providers nationwide are planning to purchase an inpatient computer-assisted coding (CAC) solution within the next two years, according to a new report from KLAS.
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VC funding for health IT breaks record in Q1
April 17, 2012 | Bernie Monegain
Venture capital funding in the healthcare information technology sector for Q1 2012 totaled $184 million in 27 deals, the highest number ever recorded, according to Austin, Texas-based consulting firm Mercom Captal Group.
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Payers moving toward trigger-based communications
April 16, 2012 | Mike Miliard
A new study from IDC Health Insights finds that more than half of health plans will invest in trigger-based communications, which use data analytics to detect a consumer's current status, and automatically initiate relevant communications, to prompt plan members to take health and wellness action.
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CMS awards $111M contract for health IT app
April 16, 2012 | Bernie Monegain
Centers for Medicare & Medicaid Services has awarded a $111 million contract to Indianapolis-based National Government Services, Inc. to support the Next Generation Desktop (NGD) over the next five years.
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Redefining Value and Success in Healthcare: Charting the Path to the Future
March 13, 2012 | On Demand Webinars
Across the healthcare industry, we are seeing forward-thinking organizations develop new competencies in anticipation of the opportunity that comes with industry-wide transformation. They are positioning themselves for success. And they are defining the future of healthcare. Will your organization be ready? Register to learn more and listen to the session now!
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Ensure Performance and Availability of Your Epic Application
March 8, 2012 | On Demand Webinars
Data-intensive <a href="/directory/electronic-medical-record-emr" target="_blank" class="directory-item-link">EMR</a> has dramatically increased storage requirements for healthcare providers and is impacting application throughput due to I/O performance challenges. In this exclusive webcast, healthcare industry experts will provide insights on how you can guarantee performance and availability SLAs for the IT infrastructure that supports your <a href="/directory/epic" target="_blank" class="directory-item-link">Epic</a> applications.
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Revenue Cycle Management: Learn How Mount Sinai Hospital Transforms Volumes of Data for Increased Revenue
February 23, 2012 | On Demand Webinars
The webcast will feature how Mount Sinai Hospital is tackling Revenue Cycle Management. The webcast will also include a Revenue Cycle Management expert from Jacobus Consulting. Datawatch will include a product demonstration to show how Revenue Cycle Management is easily handled through the use of Report Analytics.
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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 <a href="/directory/bundled-payments" target="_blank" class="directory-item-link">bundled payments</a>, 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 (<a href="/directory/healthcare-associated-infections-hais" target="_blank" class="directory-item-link">HAIs</a>).
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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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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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