Claims Processing
Data mining is both an art and science. Roughly stated, the purpose is to extract useful information from data.
The Department of Health and Human Services (HHS) took the first steps to implement an Affordable Care Act provision that cuts red tape in the healthcare system and saves an estimated $12 billion over the next ten years.
Payers are on track for the implementation of ICD-10 and do not anticipate problems with processing payments -- at least according to Ian Bonnet, vice president leading the ICD-10 rollout at health insurer Wellpoint.
The Centers for Medicare & Medicaid Services (CMS) has selected defense contractor Northrop Grumman to develop and implement a fraud prevention system to help identify high-risk claims in support of the National Fraud Prevention Program.
Experian is expanding its healthcare business by purchasing Medical Present Value, a revenue cycle management company headquartered in Austin, Texas, for $185 million.
In a deal with eyes on the future of payment bundling and risk sharing among payers and providers, McKesson has announced an agreement to buy Portico Systems for a reported $90 million.
According to the Centers for Medicare & Medicaid Services, Recovery Auditor Contractors are adjusting claims to align provider payments with Medicare guidelines related to the technical component (TC) of radiology services.
The Healthcare Financial Management Association has named 12 healthcare organizations as winners of the 2011 MAP Award for High Performance in Revenue Cycle. Winners will be recognized at the upcoming ANI: The Healthcare Finance Conference.
The average medical claims error rate in 2010 climbed to 19.3 percent, a two percent increase from the previous year, according to the American Medical Association's fourth annual National Health Insurer Report Card.
Healthcare has a large number of coders fixing claims just before they go out the door. Very often, it is the same types of edits that are being fixed on a daily basis. This is time-consuming and labor intensive. It also increases days in A/R. Yet it is status quo for many in healthcare.