Tag: Healthcare providers

2021 HIPAA in Review

2021 HIPAA in Review

Break out your pen and paper because if you haven’t already started your list of new year’s resolutions, the past 12 months have given us plenty of ‘New Year, new me’ examples to take note of. From ratified legislation and appointed government officials to trending cyberthreat tactics (and binge-worthy Netflix series), there have been plenty […]
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How Population Health, Risk Stratification Support Value-Based Care

How Population Health, Risk Stratification Support Value-Based Care

To excel in value-based care, providers must lean on strategies for managing population health and skillful risk stratification. Amid the COVID-19 pandemic, organizations observed the ramifications of fee-for-service, leading to communication and revenue challenges for both providers and patients. While value-based care is not a novel idea, the pandemic greatly accelerated the adoption of this […]
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HHS distributing $9 billion in COVID-19 relief funds to providers this week

HHS distributing $9 billion in COVID-19 relief funds to providers this week

Average payments are $58,000 for small providers, $289,000 for medium providers, and $1.7 million for larger providers. The U.S. Department of Health and Human Services, through the Health Resources and Services Administration (HRSA), said it’s distributing about $9 billion in Provider Relief Fund payments to providers, with a particular focus on smaller providers. This is […]
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Humana Expands Medicare Advantage Value-Based Contract in Minnesota

The payer will expand its partnership with Allina Health to cover more members under Medicare Advantage value-based contracts. “This value-based agreement for Humana Medicare Advantage members is an important part of helping our members achieve their best health,” Chuck Dow, vice president and Medicare regional president for Minnesota at Humana. “We’re excited to share with […]
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The Steps You Can Take to Defend Against Exclusion of Zero-Paid Claims

The Steps You Can Take to Defend Against Exclusion of Zero-Paid Claims

Zero-paid claims are defined as any claims submitted by healthcare providers that are not paid. The problem is that when performing statistical extrapolations, auditors (ZPICs, or Zone Program Integrity Contractors, and others) routinely screen out zero-paid items when they extract the claims from a sample. This is a violation of at least 12 parts of […]
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early-warning-hospital-billing-errors-portend-bleakness

Early Warning: Hospital Billing Errors Portend Bleakness

Hospitals across the nation are seeing lower profits, and it’s all because of a sudden tsunami of Medicare and Medicaid provider audits. Whether it be by Recovery Audit Contractor (RACs), Medicare Administrative Contractors (MACs), Unified Program Integrity Contractors (UPICs), or otherwise, hospital audits are rampant. Billing errors, especially “supposed bundling,” are causing a high rate […]
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As Revenue Cycle Management Expands, Automation Is Key

As Revenue Cycle Management Expands, Automation Is Key

  In its simplest form, revenue cycle management is the process healthcare providers use to ask for, track, and collect revenue for services rendered to patients. But as medical billing gets more complex, revenue cycle management is expanding beyond the business office. At Jackson Hospital in Montgomery, Alabama, for example, revenue cycle management also includes […]
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