Razor-thin operational margins coupled with substantial and ongoing losses related to COVID-19 are culminating in a perfect storm of bottom-line issues for U.S. hospitals and health systems. A study commissioned by the American Hospital Association (AHA) found that the median hospital margin overall was just 3.5% pre-pandemic, and projected margins will stay in the red for at least half of the nation’s hospitals for the remainder of 2020.
The reality is that an increase in
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Healthcare Claims
Verisk Acquires MSP Compliance Provider Franco Signor for $160M
What You Should Know:
- Verisk acquires Franco Signor, a Bradenton, FL-based full-service provider of MSP compliance software and services for $160M.
- Property/casualty insurers, self-insureds, and TPAs
will benefit from the most comprehensive suite of fully integrated Medicare
compliance solutions and greater access to the nation’s top Medicare experts.
Verisk, a data
analytics provider, announced today that it has acquired
Franco Signor, a Medicare Secondary
Payer (MSP) service
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HealthEdge Acquires Payment Integrity Solution The Burgess Group
What You Should Know:
- HealthEdge Software announces the acquisition of The Burgess
Group, LLC (“Burgess”), an innovative payment integrity software company
focused on improving healthcare payment operations for an undisclosed sum.
- The strategic acquisition will boost Health Edge’s position in
the payment integrity market and extends best-in-class claims processing to
include software-driven payment integrity
- Burgess’ product, Burgess
Source®, is the first solution to natively
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Why Government-Supported Health Plans Must Make Encounter Submissions A Top Priority in 2020
Encounter data such as diagnosed clinical conditions and services, or items delivered to healthcare consumers to treat these conditions is the key to success for all healthcare organizations participating within the government space. Whether doctors or hospitals are submitting data for medical services rendered under Medicare Advantage, the Affordable Care Act’s state exchanges or Medicaid, encounter data is used for payment reimbursement and reconciliation between the health plan and the
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Mastercard Unveils Suite of Healthcare Solutions to Detect Fraud & Protect Health Data
- Mastercard unveils new suite of healthcare solutions to move beyond cards and reimagining how its technology and capabilities can benefit the healthcare ecosystem. - Mastercard Healthcare Solutions will develop and provide the tools needed to protect detect fraud, waste, and abuse, capture more revenue, and protect patient health data.Mastercard today unveiled Mastercard Healthcare Solutions, a new suite of products dedicated to helping healthcare partners detect fraud, waste, and abuse,
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Change Healthcare: Applying AI Could Identify Up to 35% of Denials Prior to Submission
Change Healthcare AI can help providers identify problem claims and prevent denials before they happen, avoiding costly rework, delays, and improving revenue flow.Today Change Healthcare announced that it has applied its Claims Lifecycle Artificial Intelligence (AI) technology to its claims management suite with the introduction of Assurance Reimbursement Management™ Denial Propensity Scoring and Revenue Performance Advisor Denial Prevention. With performance enhanced by Claims Lifecycle AI,
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Change Healthcare Unveils Claims Lifecycle Artificial Intelligence
Change Healthcare today announced Claims Lifecycle Artificial Intelligence, a new capability being integrated into the company’s Intelligent Healthcare Network and financial solutions, to help providers and payers optimize the entire claims processing lifecycle.Claims Lifecycle AI OverviewThis Change Healthcare Claims Lifecycle AI service is trained on more than 500 million service lines making up over 205 million unique claims that touch $268 billion in charges. The service leverages the
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Waystar Acquires UPMC’s Ovation Transaction Services Business for Enhanced Claims Monitoring Capabilities
Waystar(formerly known as ZirMed), a provider of healthcare revenue cycle management services, today announced it will be acquiring a major part of the transaction services technology business of Ovation, a health information management and management cycle solution currently owned and operated by University of Pittsburgh Medical Center (UPMC). Financial details of the acquisition were not disclosed.Ovation Transactions uses advanced algorithms to monitor claims at many health systems and
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Change Healthcare Launches Front-End Denials Management Tool for Providers
Change Healthcare today unveiled a new technology that helps providers reduce one of the leading causes of claim denials. Assurance Attach Assist™, a module of Change Healthcare Assurance Reimbursement Management™, now anticipates what documentation a payer—including Medi-Cal and seven other payers—may require to help prevent the denial of a claim due to lack of documentation. The result: Providers can now use Assurance Attach Assist’s automation as a tool to proactively decrease
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7 Reasons Why Claims Data Cannot Drive Patient Health Improvements
With the Department of Health and Human Services' decision to tie 90 percent of Medicare payments to value based models by this year, we can expect organizations to move even faster toward streamlining their population health management programs. But a survey from Managed Healthcare Executive notes that only 12% of survey respondents say their organization is using data “very well” and it’s making a “big impact” at their organization, the same percentage as 2016. Obviously there is still a steep
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