A Push to Streamline Value-Based Payment
Value-based payment is ripe to repeat past fee-for-service problems—widespread slowdowns as each entity took different approaches to data collection and sharing and, as a result, hampering interactions. CAQH CORE is getting in front of these challenges now.
How to Get Involved in CAQH CORE’s Work
CAQH CORE currently is forming groups to work on healthcare data standardization. Healthcare finance professionals are a core constituent and CAQH welcomes their participation.
Preparing for Rising Patient Financial Responsibility
Average patient out-of-pocket healthcare costs increased 11 percent in 2017. Learn the strategies revenue cycle leaders can implement to address this growing concern.
Should utilization review report to patient care or revenue cycle?
Utilization review should work as part of a productive whole, alongside many other areas, says a former Cleveland Clinic finance executive. The function can report to finance, administration, operations, and even patient experience.
3 Strategies for Taking Control of Payer Management
Three strategies can help hospitals and health systems prioritize payer contract management.
Payer access to EHR data improves cash flow
Sharp Healthcare gives some payers limited access to their members’ EHR data, which reduces the time-consuming cycle of level-of-care authorization denials, appeals, and ultimate approvals.
Limiting Emergency Department Denials and Surprise Bills
As health plans introduce new policies affecting emergency department patients, hospital and revenue cycle leaders must be proactive to ensure that patients get the right care—and that claims are handled appropriately.
Your To-Do List When Health Plan Contracts Change
Six steps can help revenue cycle leaders manage health plan changes effectively.
Exemptions to Anthem’s ED Policy
Anthem will not deny an ED claim based on the prudent layperson standard if certain conditions apply.
HIPAA Compliance Needs Improvement
While technology changes over the past 22 years have allowed increasingly skillful data breaches, we can expect even more dramatic developments in the next five years. Attention to potential breaches now—in all their various forms—will be essential to managing unforeseen future threats.