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.
OCR Offers Guidance on Sharing Patient Behavioral Health
OCR has proposed deregulatory rulemaking to clarify when hospitals may share certain patient behavioral health information.
Avoid ED Claim Challenges by Developing CDI Teams
UnitedHealthcare’s new policy of auditing certain emergency department claims should prompt hospitals to seek the expertise of clinical documentation improvement teams in outpatient claim processing.
Enterprisewide Revenue Cycle Management Reduces Costs, Improves Patient Loyalty
Moving toward a holistic approach to revenue cycle management addresses increasing consumer demand for streamlined appointment scheduling, patient information sharing, and bill payment.
Supreme Court Narrows Whistleblower Law
A Supreme Court decision affects whistleblowers in for-profit companies; those working for not-for-profits are protected by other statutes.
BCBS Case is a Lesson on Antitrust
A U.S. district court judge recently questioned the reasonableness of the claims against BCBS that accuse the health plan of increasing coverage opportunities by eliminating competition.