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

 
Much of healthcare reform involves changing the relationship between providers and patients. But for providers, efforts to deliver more accountable care necessarily involves changing the way they manage their practices and keep abreast of near-constant developments across healthcare.
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May 23, 2013
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Healthland, which develops information technology for rural hospitals and care facilities, announced Tuesday its acquisition of Jackson, Miss.-based American HealthTech, which specializes in electronic health records for post-acute care.
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May 22, 2013
News
Cigna has announced that it will enlist the help of MDLIVE, a developer of telehealth technology and services, to offer eligible health plan members round-the-clock online video consultations with internal medicine, family practice and pediatric doctors.
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May 10, 2013
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Marilyn Tavenner, acting administrator of the Centers for Medicare & Medicaid Services, received accolades from both sides of the aisle at a hearing on April 9 to consider her nomination to head CMS. Senate Finance Committee leaders indicated a decision would come soon.
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April 28, 2013
News
The Centers for Medicare & Medicaid Services reports it has paid out nearly $12.7 billion in meaningful use incentive payments through February 2013, according to the latest figures available.
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April 28, 2013
News
The Department of Health and Human Services unveiled its $967 billion for the 2014 fiscal year on April 10. It includes funding increases for programs in the Centers for Disease Control and Prevention, the National Institutes of Health, early childhood education, mental health and substance abuse treatment and Affordable Care Act implementation, with certain portions of the budget subject to Congressional approval, such as a $1.5 billion request for federally-facilitated insurance exchanges.
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April 28, 2013
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The pressure to innovate is on as healthcare looks at how to meet the new business demands of moving to pay for performance and quality measures. Part of that process may be the retooling of the Health IT leadership team.
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April 28, 2013
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Florida Blue, the Sunshine State's largest insurer, has launched a project with data exchange platform Availity and ambulatory electronic health record vendor Greenway that will enable physicians to exchange clinical summaries with the health plan through their EHRs.
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April 18, 2013
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Healthcare organizations should not assume that compliance with regulations, like HIPAA, automatically makes their organization secure, says Larry Hurtado, CEO of Digital Defense, a risk assessment firm in San Antonio, Texas.
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April 16, 2013
News
The Workgroup for Electronic Data Interchange announced Thursday that it had submitted its ICD-10 industry readiness survey to the Centers for Medicare & Medicaid Services. Its findings continue to show insufficient readiness for the October 2014 transition deadline.
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April 12, 2013
News
Marilyn Tavenner, acting administrator of the Centers for Medicare & Medicaid Services, received accolades from both sides of the aisle at a hearing on Tuesday to consider her nomination as head of CMS. Senate Finance Committee leaders indicated a decision would come soon.
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April 10, 2013
News
Since 2007, and in the wake of the Great Recession, an additional 10 million Americans have enrolled in Medicaid, at the same time that states' tax revenue declined. But those long-plagued by Medicaid debt are starting to address their problems, several states are forging ahead with accountable care innovations and the consumer experience is becoming an increasingly important point of focus as states begin to modernize their systems.
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April 8, 2013
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In this Webinar, we will address health BI challenges and discuss our end to end business analytics platform that transforms the data center, enables modern applications, unlocks insights on any data, and empowers people centric IT.
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May 15, 2013
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Recent headlines have raised plenty of eyebrows with record setting big-dollar penalties levied against healthcare organizations due to HIPAA violations. Industry experts surmise that this unprecedented trend is the result of significant changes that have occurred recently to HIPAA regulations.
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May 14, 2013
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The CMS EHR Incentive program (commonly known as Meaningful Use) is not just about getting all providers to use EHRs. It’s creating a foundation of detail clinical and administrative data – all expressed in the same standard vocabulary – that can be used to automate the calculation and reporting of patient outcomes. With the shift from volume to value in care delivery and reimbursement models, comprehensive quality measures are an essential element – else how can we determine value? But the historical approach to measuring quality using manually abstracted data will not work in a healthcare environment focused on value. Quality metrics must be automated. The industry must shift to eMeasures – metrics calculated and reported based on data captured in the EHR as a by-product of care delivery. This spring, CMS published the timeline for implementing a unified set of electronic clinical quality measures (eCQMs) and e-reporting requirements intended to synchronize and integrate CMS quality programs and reduce provider reporting burden. Are you prepared to embark on the journey to the new generation of quality measures and reporting?
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May 6, 2013
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In healthcare organizations today, it's all about getting the most from the technology you choose by providing versatility. One monitor mounted on a wall in a patient room, programmed at the back end with applications, cable and other features, can deliver a host of multimedia choices. These can range from TV, movies, music, Internet access, email and games to educational information, treatment tips and even meal menus - far from the days of simple in-room television.
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May 6, 2013
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The Office of the National Coordinator has specified the use of RxNorm as the medication and medication allergy vocabulary constraint within certified systems which enable Meaningful Use Stage 2 clinical information exchanges. Specifications for the electronic computation of clinical quality measures (CQM) leverage “eMeasures” and their associations to medication and medication allergy value sets to enable the programmatic computation of summary CQM reports for CMS submission.
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April 30, 2013
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As healthcare reform continues its fast and uncertain path, healthcare organizations know no matter what, information is going to be key in providing insights into their business. It can help to identify trends in services and costs so changes can be made. Simply getting to the information can be a challenge on its own, but the key is accessing information, having the right tools to be able to unscramble the information to drive change improvements, and be the catalyst that will drive your organization to consider making a move today.
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April 29, 2013
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Microsoft Office 365 brings together online versions of Exchange, SharePoint and Lync along with our familiar Office Professional Plus suite. It is designed to help meet healthcare organizations’ need for patient-centered collaboration, robust security and adherence to privacy regulations, including full support for a HIPAA Business Associate Agreement. Microsoft Office 365 provides the user experience, productivity, and IT management capabilities that healthcare enterprises have come to know and trust for mission-critical applications while affording decision-makers the flexibility in meeting challenging business scenarios through implementation and licensing options.
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April 25, 2013
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The regulatory environment continues to become more stringent as HIPAA regulations require nearly every healthcare organization to maintain an easily accessible and complete archive of electronically stored information (ESI). Healthcare IT departments are pulled in many directions in order to stay aligned with federal requirements for access control, integrity, and transmission security for patient communications or implementing Electronic Medical Records (EMR) systems. Managing communication systems is an unnecessary burden that ultimately distracts IT teams from contributing towards the improvement of patient care. Today, healthcare providers can turn to hosted services to more easily meet the security and privacy requirements for electronic Protected Health Information laid out in the HIPAA Security Rule, the American Recovery and Reinvestment Act’s HITECH requirements, and other federal regulations.
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April 10, 2013
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In today’s healthcare environment, there is increasing internal and external pressure to improve outcomes, reduce costs and maximize reimbursement for patient care. All parts of the hospital have a stake in meeting these pressures. To maximize results, an integrated strategy to map detailed clinical information and supply clinicians’ timely and efficient navigational tools at the point of care, can allow teams to identify the highest opportunities and drive meaningful change and improvement. Learn how in this informative, interactive webinar.
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April 9, 2013
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The multimillion-dollar question is: Are you covering who you think you’re covering? This white paper gives insights into the scope of eligibility fraud among commercial managed care organizations, state employee health plans, and state and federal agencies. It also addresses why it is important to incorporate multiple, diverse data sources into your analysis to spot inconsistencies and anomalies. Lastly, read about five real-world case studies of eligibility fraud detection in action.
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April 2, 2013
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Atlantic Health System is leading the way in connecting healthcare providers with one another and with patients to help improve care coordination and patient engagement. Increasing levels of clinical connectivity in parallel with improved financial connectivity are driving better care and better financial outcomes. Read Atlantic Health’s story to learn about the incremental steps taken to establish the Jersey Health Connect HIO and about revenue cycle process improvements to improve financial performance via a relationship with RelayHealth.
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February 27, 2013
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During this webinar, healthcare innovators will explore and discuss how current issues such as rising healthcare costs and clinical inefficiencies require a drastic shift in the way healthcare is practiced.
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December 20, 2012
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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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November 22, 2011
Blog
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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March 1, 2011
Blog
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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August 6, 2010
Blog
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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April 8, 2010
Blog
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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February 4, 2010
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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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November 10, 2009
Blog
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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February 9, 2009
Blog
Wellsoft Corporation has announced that Continuum Health Partners (CHP), based in New York City, has selected Wellsoft’s Emergency Department Information System (EDIS) to support its goal of improved patient care in their four Emergency Departments located in the boroughs of Manhattan and Brooklyn.
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May 16, 2013
Press 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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October 27, 2011
Press 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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September 13, 2011
Press 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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June 20, 2011
Press 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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June 15, 2011
Press 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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June 2, 2011
Press 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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May 25, 2011
Press 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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April 28, 2011
Press Release
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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April 21, 2011
Press Release