3 Ways Payers Can Review Insurance Claims More Efficiently

Posted by Advent Health Partners on Nov 29, 2017 9:30:00 AM

There are two different methods hospitals use to deliver insurance claims to payers: on paper and electronically.

Most healthcare providers have adopted payers’ prefered method of an electronic claim system. An electronic claim system that is integrated into an EHR allows for a faster, more accurate, and cheaper way to process claims.

But because paper claims have not yet been completely removed from the insurance claims process, payers face a challenge - how can they aggregate all of their data all in one place?

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How Technology Can Solve Payment Integrity Challenges

Posted by Advent Health Partners on Aug 29, 2017 1:30:00 PM

Payment integrity has become an essential part of the process for healthcare organizations, but it's traditionally been given a lower priority in resources. As Healthcare Tech Outlook noted, organizations often devote their IT and analytics resources to specific concrete areas, such as billing or claims. If your organization focuses more on payment integrity as an umbrella to ensure that the overall revenue cycle management of your organization runs smoothly, technology and analytics can significantly improve your projected data and bottom line.

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6 Strategies for Improving the Payer Provider Relationship

Posted by Advent Health Partners on Jun 13, 2017 1:46:54 PM

Contention over claims and contracts can cause the payer provider relationship to become strained. Despite improvements in how insurers and physicians collaborate, their relationships are often stymied by a lack of trust. However, adopting these six strategies can help insurers and providers build credibility, making the claims process easier to navigate.

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What Payers and Providers Should Know About Medical Record Analytics

Posted by Advent Health Partners on Mar 8, 2017 8:15:00 AM

Providing exceptional healthcare involves a multitude of moving parts. Admissions, clinicians, labs and imagers, pharmaceuticals, payers, regulators, billing and collections, plus various device and material suppliers all touch patient care one way or another. Each element generates its own data sets, and each set relates to the rest. Aggregating all relevant data that contributes to patient medical records and rendering it actionable has always been a massive undertaking that requires an abundance of administrative resources. Even so, gaps still exist, allowing patient satisfaction and payer reimbursements to slip through the cracks from time to time. When they do, pain often ensues.

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6 Claim Denial Headaches For Insurance Payers

Posted by Advent Health Partners on Feb 22, 2017 12:17:46 PM

A rather popular myth circulates among healthcare providers that says insurance payers deny or reject claims for arbitrary reasons. What they seldom consider is the fact that insurers, like hospitals and practices, compete for customers. If insurers gain a reputation for frivolously refusing claims, it's bad for business. Customers will start shopping for a new carrier if their current one cannot be trusted.

In truth, claim denials happen for a variety of reasons. Considering that most of the claims process ensues in manual form, many mistakes can be made on either side. Payers must deal with the fallout from unpayable claims, too, which eventually impacts the bottom line of the company. Following are six claim denial headaches faced by payers.

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A Win-Win Proposition: Improving Your Payment Reimbursement Process

Posted by Advent Health Partners on Jan 16, 2017 10:20:00 AM

As insurance payment reimbursement shifts downward, hospitals can't afford to let underpaid or denied claims simply go unrequited. Although the costs associated with pursuing those claims once seemed high enough to encourage write-offs as an acceptable RCM solution, there is now a better option to give each payer what they want so they can honor their contracts and pay claims the first time around. To do this, a hospital's financial department should identify the problematic areas of claim denials and attack the difficulties at their roots.

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Preceding NHCAA: Handling Healthcare Fraud, Knowledge & Technology

Posted by Advent Health Partners on Oct 28, 2016 9:04:00 AM

Healthcare fraud amounts to over 10% of the United States’ Gross Domestic Product(GDP), costing the U.S. between $125-230 billion dollars annually. Unwanted financial suffering is knowingly at the expense of government and commercial payer organizations and secondhandedly affects the consumer. As fraudulent behavior rises, payers see a reduction in profits, creating a trickle down to the consumer in the form of higher deductibles and steep payment rates to cover imposed costs. Case in point: Healthcare fraud impacts everyone.

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Solving Abrasion Between Payers and Providers Through Technology

Posted by Advent Health Partners on May 26, 2016 5:04:00 AM

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