Claims Processing
Two professional organizations representing emergency doctors warn that a new federal rule could lead to higher out-of-pocket costs for consumers when they need emergency care outside their health plan's network of providers. But consumer advocates and health policy experts say the groups' proposed solution doesn't adequately protect consumers.
As patients face high deductibles, price is a major topic that's put pressure on healthcare providers to offer price transparency, even though what a hospital charges can be far different from what a patient actually owes after their insurance covers some of the costs.
As HEDIS scores have become increasingly important to the bottom line, many plans are getting great results and easing the reporting burden by focusing on year-round data collection and intervention strategies.
Organizations of all sizes can achieve cost savings and benefits from converting their claims reimbursements payments from paper checks to the healthcare EFT standard transaction. Here are some examples of those who did it.
For example, among narrow network plans, median premiums are 10 percent higher for plans with an academic medical center than for those without.
It is important to both health plans and providers that the originator of an Electronic Funds Transfer (EFT) is easily and correctly identified, and that associated Electronic Remittance Advice (ERA) is sent in a timely manner, to eliminate the need for time-consuming follow-up.
Owners are also charged with wire fraud for allegedly filing fraudulent applications for relief relating to the explosion and fire which occurred on the Deepwater Horizon oil rig in April 2010.
After a fractious price battle with Blue Shield, Sutter Health is offering more patients a direct option through its own health plan.
To remain competitive, physician practices must not only provide the best clinical care to their patients, but also optimize the way they manage revenue, making sure they preserve cash flow, limit bad debt and receive full reimbursement for services rendered.
New payment models and technology in healthcare are bringing big changes to the hospital controller job as "following the money" has become more complicated than ever.