By David Shelton – A staggering 90% of physicians say manual prior authorizations are a concern, according to the 2019 CAQH Index. Further magnifying the current situation are payers’ intentions to increase prior authorization requirements for even more services in the near future.Read More
Healthcare Revenue Cycle and Finance
By Pamela J. Gallagher – Patients have been begging for affordability for decades, and the healthcare industry’s reluctance to innovate and adapt to patient demands has left a door open for retailers to move into the healthcare business. I believe this will be great for healthcare, but potentially disastrous for health systems.
Latest news being reported on payers and the health insurance industry including news from Cohere Health, Humana, HST, UnitedHealthcare, Anthem, Bind Benefits, CVS Health, Blue Cross Blue Shield Association, Cigna Corporation, Oscar Health, Aetna and more.
By Angela Jordan – The Transitional Care Management codes (99495, 99496) introduced in 2013 allow providers to report and capture reimbursement for the work involved with providing continuity of care to patients discharged from a hospital or other qualified stay, back into their community setting.
By Emad Rizk MD – COVID-19 exposed many weaknesses in our healthcare system and exacerbated fraud, waste and abuse. As the federal government waived restrictions around various reimbursements for Medicare patients as well as encouraged plans to be more…
By Pamela J. Gallagher – In 2019, emergency departments across the U.S. saw an average of 2.1 million patients per week, according to the CDC. Over the past several decades, healthcare organizations have invested large amounts of money, time, and effort to study the trend of…
NAACOS reported that Medicare’s largest alternative payment model by far had another record year of savings while continuing to provide high-quality care, as shown by data on 2019 performance released by CMS. Check out ACOs reporting savings.
Latest news being reported on payers and the health insurance industry including news from insuranceQuotes.com, Centene Corporation, CVS Health, AVIA, Independence Blue Cross, Premera Blue Cross, CareFirst BlueCross BlueShield, ArmadaHealth, Blue Cross Blue Shield Association, UnitedHealthcare, Humana, Cigna Corporation and more.
By Devin Partida – Medical professionals prioritize giving people high-quality care and ensuring those patients get paid for that treatment via successful insurance claims. When a person deals with too many denials, their insurance plan becomes largely useless.