Claims Processing

There's a tremendous amount of waste occurring in the healthcare industry. Organizations are moving to lean management because it exposes what and where these wastes are and rethinks the way work is done via value streams. Healthcare Finance News talked to a lean management expert to take a look at how waste impacts organizations.

Despite all the innovations in the healthcare industry, the sad truth is that errors with wrongly prescribed medication are happening more than ever. Not only can this be costly for healthcare organizations, it can also have tragic consequences.

While many private payers across the country have rushed to launch payment initiatives wrapped around healthcare delivery models like ACOs and patient-centered medical homes (PCMH), Washington-based Premera Blue Cross has found success via its unique payment model it calls Global Outcomes Contracting.

The U.S. Department of Health and Human Services (HHS) on Aug. 7 released an interim final rule for making healthcare claim payments electronically and describing adjustments to claim payments. The department expects this next step in the adoption of operating rules to save up to $9 billion over the next 10 years.

Home health agencies inappropriately paid $5 million for home health claims in 2010, found the Office of Inspector General in an examination of home health agencies' billing practices.

Studies have illustrated the potential benefits of EHR adoption, such as improvement in the clinical care process and the overall patient experience. EHR implementation, however, can also have a significant impact on operational efficiencies, creating opportunities for healthcare organizations to leverage the same workflow automation capabilities to improve a number of cumbersome administrative processes to drive bottom line improvement.

Grand Junction, Colo., gets a lot of credit and attention as being home to pioneers in providing high-quality, low-cost healthcare. Healthcare leaders in the city of more than 58,000 are once again demonstrating their initiative.

When it comes to patient experience, U.S. safety-net hospitals -- those serving a disproportionately larger number of low-income and Medicaid patients -- are getting poor performance reviews, which may indicate they will struggle under value-based purchasing models.

With the financial pressures that healthcare organizations are facing, many hospitals are using traditional cost cutting methods to save money by looking at layoffs and staff reductions. Many more hospitals, however, are finding ways to reduce costs through lean management methods that don't require layoffs and can improve quality for patients.

An interim final rule adopting electronic funds transfer (EFT) standards has been finalized announced the Centers for Medicare & Medicaid Services last week.