Claims Processing

The Obama administration took another step to close what many see as a health-law loophole that allows large employers to offer medical plans without hospital coverage and bars their workers from subsidies to buy their own insurance.

More healthcare providers are outsourcing end-to-end revenue cycle management amid the change to value-based payment models, a new survey shows. Experts predict the market for RCM outsourcing will approach $10 billion by 2016.

The Affordable Care Act's online insurance exchanges launched this weekend with far fewer problems and less fanfare than last year. Many people qualified for federal subsidies that kept their monthly premiums well under $100.

For many Americans, the ACA open enrollment period offers them an opportunity to have health insurance for the first time. But for hospitals and healthcare organizations, ACA open enrollments create financial and operational challenges.

Hospitals' struggle for financial sustainability continues and may be getting worse, as CFOs say information technology investments draw more resources than expected and threaten to crowd out other priorities.

It's the rare hospital that has never experienced delays in receiving reimbursement as a result of clinical documentation coding snafus. But hospitals that don't make a serious stab at clinical documentation improvement (CDI) will be poised to take an even harder hit come October 2015, the start date for ICD-10 implementation.

Commercial insurers inaccurately process about 20 percent of claims filed by medical practices. It's an industry standard that has weathered the test of time -- though not in a good way.

The offical transition to the ICD-10 coding set takes place next October (or so we hope). Many providers have already spent a good deal of money preparing for the inevitable, but even so, you need to make certain that select ICD-10 costs are included in your 2015 budget.

Some health systems see value in becoming part of branded health plan networks for limited provider plans, as other providers try to launch their very own plans.

With an annual rate of 11,000 fatalities from falls in U.S. hospitals, falls are a persistent concern for healthcare facilities. They raise issues of care quality and are increasingly a financial issue.