By Ritesh Ramesh – Overcoding may net higher reimbursements for healthcare organizations, however the ramifications of getting caught far outweigh the revenue boost – and the likelihood of that happening are high as CMS continues its quest to ferret out fraud and abuse and recoup improper reimbursements.
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Latest news being reported on payers and the health insurance industry including news from Independence Blue Cross, Aetna, CVS Health, Humana, CareSource, MultiPlan, ECHO Health, AHIP and more.
By Tom Dorsett – Drug costs are skyrocketing, but why? First we must understand the cause of high drug costs in order to properly address the problem. For more than twenty-five years, I’ve seen drug costs grow and dominate pharmacy budgets across the United States.
By Devin Partida – The healthcare industry experienced a steep increase in IT roles during the COVID-19 pandemic, but an economic downturn may force it to scale back. Cybersecurity is critical for compliance reasons, so hospitals must prepare their teams for the effects of a recession.
By Pamela J. Gallagher – The emergence of artificial intelligence is the topic on every healthcare leader’s mind. In many ways, though, AI is old news to those of us in healthcare finance. I can say from experience that once an AI technology comes onto the scene, there is no stopping it. AI is here to stay.
By David Burda – Accuracy is a pillar of healthcare consumerism. It’s the most important pillar. If we want patients and members to make informed decisions about their medical care and their health insurance, they need accurate information to make the right choices for them.
Latest news being reported on payers and the health insurance industry including news from CVS Health, IBX, UnitedHealthcare, Humana, CareSource, Cigna, AHIP, Superior HealthPlan and more.
By Jane Austen – Healthcare revenue cycles struggle with claim denials. Denial management investigates each denial, determines why it was denied, and determines how to fix the problem and reduce future denials. Sophisticated and robust automation, designed to meet providers’ needs and achieved through AI and ML, empowers organizations to…
By Deepali Narula – A three-pronged approach hospitals should follow to navigate denials, optimize revenue and mitigating staffing shortages Three out of four hospitals in the U.S. have experienced revenue cycle issues since the COVID-19 pandemic.