Tag: healthcare payers

Key Benefits of Using Total Practice Management System

Key Benefits of Using Total Practice Management System

Providers draw more on-time and uncut payer reimbursements and patient payments by automating these operations with a quality practice management system Via using a quality total practice management system, your company can evade putting as much attempts into accomplishing quality work and rather find effectiveness, accuracy, and peace of mind. An integrated billing and scheduling […]
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Payers Wrongly Cutting Payments To Physicians For E/M Services

Payers Wrongly Cutting Payments To Physicians For E/M Services

Payers have been wrongly cutting payments to physicians for evaluation-and-management (E/M) services—often automatically through the use of claim-editing algorithms. A new AMA resource helps physicians fight back against health insurer downcoding. Downcoding happens when a payer changes a claim to a lower-cost service than what was submitted by the physician, leading the practice to get […]
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60% of Consumers seek Healthcare Price Transparency

60% of Consumers seek Healthcare Price Transparency

A survey shows that 60% of consumers who look for pricing information seek answers from their insurance companies, but healthcare price transparency should still be a priority for providers. Not many consumers are asking how much healthcare services cost but among those who do, they are seeking answers primarily from their insurance companies, according to […]
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Claim Denial Rates as High as 80% for In-Network Services

Claim Denial Rates as High as 80% for In-Network Services

A new analysis shows that claim denial rates for in-network services among Healthcare.gov marketplace payers varied significantly, with some as high as 80%. Claim denial rates varied significantly among Healthcare.gov marketplace payers, with some insurers racking up rates as high as 80 percent, according to a new analysis from Kaiser Family Foundation. Marketplace payers must […]
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5 Benefits of Addressing Payment Integrity Before Payments Are Ever Made

5 Benefits of Addressing Payment Integrity Before Payments Are Ever Made

Payment integrity in Medicaid—the concerted effort to keep tight control over fraud, waste and abuse—can be addressed at any stage in the claim cycle. Of course, the earlier it is addressed, the easier it is for health plans to avoid improper payments and the administrative burden of recovering them. And while pre-payment integrity programs maximize […]
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Electronic Payment Key to Streamlining Healthcare Claims Management

Electronic Payment Key to Streamlining Healthcare Claims Management

The complexity around healthcare claims management is a major pain point for provider organizations, big and small. The increasing cost of claims coupled with a complex system of many payers, each with their own rules and requirements, creates administrative burdens and obstacles for providers. Ultimately, this complex system impacts the patient experience, as patients must […]
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Health Equity and SDOH: A Payer Perspective / Update

Health Equity and SDOH: A Payer Perspective / Update

As part of its ongoing mission to improve the health of America, the Blue Cross Blue Shield Association (BCBSA) announced its National Health Equity Strategy in April 2021 to confront the nation’s crisis in racial health disparities. This strategy is intended to change the trajectory of health disparities and reimagine a more equitable health care […]
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