Tag: Healthcare Claims

Introduction to the WHO’s ICD-11

Introduction to the WHO’s ICD-11

Cluster coding is a new feature for coding professionals. The World Health Organization (WHO) began developing the International Classification of Diseases, Eleventh Version (ICD-11), in 2007, and first released a preliminary version for evaluation and testing in 2016 – ironically, just one year after the U.S. finally adopted a clinical modification of the WHO’s ICD-10 […]
Learn More
Claims Payment Transformation Benefits Payer, Providers, and Members

Claims Payment Transformation Benefits Payer, Providers, and Members

Payers, providers, and members can all benefit from transforming the manual and patchwork claims payment process to a digital environment that also automates claims data delivery. Payers, providers, and members are all central to the healthcare experience, working together to create a seamless, coordinated encounter from registration and the clinical visit to claims payment and […]
Learn More
Optum partners with SSM Health and will employ certain revenue cycle staff

Optum partners with SSM Health and will employ certain revenue cycle staff

To reduce care variation, SSM and Optum will use clinical technologies, advanced analytic and data-driven insights at the point of care. Certain SSM Health revenue cycle staff and hospital care management will become employees of Optum. They will continue to work in their current locations across Illinois, Missouri, Oklahoma and Wisconsin. WHY THIS MATTERS As […]
Learn More
Medicare Advantage Plans Drops Due To Covid-19

Medicare Advantage Plans Could See Payments Drop in 2021 Due To Covid-19, Analysis Finds

  The COVID-19 outbreak appears to have impacted claims patterns for Medicare Advantage enrollees, according to a new analysis by Avalere Health. Even though seniors are historically the most vulnerable population health-wise, their claims were down dramatically during the month of April. The survey suggests it could impact risk score factors for MA plans in 2021, driving […]
Learn More
Root Causes Linked to Claim Denials

Root Causes Linked to Claim Denials

Three revenue cycle tips are provided to reduce denied claims. Claim denials represent millions of dollars in lost and delayed net reimbursement annually. According to the American Medical Association (AMA), cost estimates of inefficient healthcare claims processing, payment, and reconciliation top out at $210 billion per year. Claim denials are so common, they’ve become a fixture […]
Learn More
Three Ways to Facilitate Better Decision-Making with Claims Automation

Three Ways to Facilitate Better Decision-Making with Claims Automation

Suggestions for conducting peer-to-peer appeals for denials management. Claims Automation has been a part of the workers’ compensation and auto casualty industries for years, but today, a large opportunity still remains to increase in the claims automation process. The future of automation in the Property and Casualty industry is not to replace jobs but instead […]
Learn More
x