How do you solve a persistent and growing problem like claims denials?
It’s been a hot topic for revenue cycle management professionals for years that’s only getting hotter with the increasing pressures of staffing shortages, challenges with staff turnover and training and ever-changing policies and protocols at the government and payer levels.
On the macro-economic level, denials contribute mightily to the growing problem of uncompensated care in America, currently estimated at $43
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Payers| Payer Industry Impact for Patients, Clinicians, and Healthcare Organizations | News, Analysis, Insights - HIT Consultant
New Medical Billing Codes You Should Know About
Physicians need to keep their billing and coding right to ensure seamless reimbursements from payers. Similarly, they should stay updated with the latest coding changes to keep their revenue cycle intact. In addition, running a successful medical practice is a daunting task as the providers need to stay updated with the industry guidelines. The year 2023 is bringing changes in medical codes to help providers reduce their burden and streamline patient care. So, providers need to stay focused on
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OpenLoop Secures $15M for White-Label Telehealth Support
What You Should Know:
- OpenLoop, a leader in white-label telehealth support services powering virtual and hybrid care across the country, today announced it has raised a $15M Series A funding.
- The round was led by Nava Ventures, with participation from new investors UnityPoint Health Ventures and PrimeTime Ventures, and existing investors SpringTide Ventures and ManchesterStory. The company also announced a new nationwide insurance payer network that allows clients to offer reimbursable
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Avaneer Health Launches its Decentralized Network and Platform
What You Should Know:
- Avaneer Health, a secure digital network for healthcare, today announced that it has launched its private, peer-to-peer network with several leading healthcare organizations. With a single connection to the Avaneer Network™, participants can collaborate and share real-time data, streamlining healthcare administration and enhancing the healthcare experience for all stakeholders.
- For decades, the healthcare industry has been challenged with fragmented
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Enabling a Better Future for All by Embracing Healthcare Interoperability
The Centers for Medicare and Medicaid Services (CMS) has laid the critical groundwork to create a connected healthcare system in which patients, providers, and payers can easily exchange information. This is thanks in part to the release of the Interoperability and Patient Access Final Rule. With new policies now in place, CMS aims to generate better health outcomes through improved interoperability and better access to health information for all stakeholders.
CMS has also identified a new
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CodaMetrix Raises $55M for AI-Powered, Autonomous Medical Coding
What You Should Know:
- CodaMetrix, an AI technology platform transforming healthcare revenue cycle management, today announced that it closed a $55 million Series A round led by SignalFire. Frist Cressey Ventures (FCV), Martin Ventures, Yale Medicine, University of Colorado Healthcare Innovation Fund, and Mass General Brigham physician organizations also participated in the round.
- The capital injection will accelerate go-to-market with major provider organizations and health systems, as
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A New Way of Thinking About Interoperability in 2023
Interoperability in the U.S. healthcare system has been an ongoing challenge. While there are several industry initiatives that are going to advance the industry and make incremental progress toward interoperability, there remain several gaps that are unaddressed.
Interoperability is a much broader concept that encompasses more than protocols, APIs, and limited networks. It’s about more than exchanging data through one-to-one connections between a provider, payer, or vendor. True
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It’s Time to Stop Accepting the Payer-Provider Dynamic as ‘Adversarial’ and Work Toward Alignment
Today’s relationship between payers and providers is more fraught than ever. With a history of transactional, often adversarial, fee-for-service contract negotiations, it’s no wonder that the healthcare industry has grown too comfortable pitting payers and providers against each other.
The lack of trust and transparency between the two groups has led to a perceived misalignment of vision. Across the board, the administrative staff has shouldered the brunt of this friction, which in the end
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Aledade Acquires Curia, Adds More Than 450 New Practices
What You Should Know:
- Aledade today announced the acquisition of Curia, a leader in value-based care analytics using practical applications of artificial intelligence (AI) to optimize the targeting of patient care and engagement programs. The acquisition will enhance Aledade’s ability to extract valuable insights from disparate data sources, provide more accurate predictions using past data, and optimize primary care workflows through cutting-edge AI algorithms.
- In addition, the
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Targeted IT Solutions Ease Navigation and Shift to Value-Based Care
The new healthcare realm of value-based care (VBC), designed to reward healthcare providers with incentive payments for the quality of care and patient outcomes not simply the volume of services provided, presents both opportunities and challenges for all stakeholders. This fundamental shift in reimbursement is intended to become part of the larger quality strategy in reforming how healthcare is delivered and compensated: better care for individuals, better health for populations
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