How Claim Review Technology Helps Government Payers Be More Productive

Posted by Advent Health Partners on Feb 13, 2018 8:30:00 AM

Settling provider claims fairly and efficiently is paramount not only for commercial health insurance organizations but for government payers, as well. Considerable resources pour into that effort even when all goes well, but when questionable claims arrive, productivity can take a dive -- and inappropriate payments can be costly.

When -- and why -- do payers waste time and money on review?

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Resolving the Document Intake and File Management Nightmare for Coders and Clinicians

Posted by Advent Health Partners on Jan 31, 2018 10:00:00 AM

Documentation in healthcare is a large issue that technology can address far more seamlessly than prior manual methods allowed. When you consider the amount of information that's collected for a single patient, the data can be immense. Multiply that by every patient who enters a facility and then further magnify that by the amount of documentation needed to run the administrative and financial aspects of an organization.

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Technology Can Easily 3x Claim Review and Intake Processes: Here's How

Posted by Advent Health Partners on Jan 16, 2018 10:32:09 AM

In an era of constant change in healthcare paradigms and regulations, claims-management can be cumbersome for payers. Consider how automation can help you triple the effectiveness of your document intake and claim review processes.

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The Impact of Medical Image Scanning on Machine Learning

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

As any reviewer who has to deal with medical claims knows, it is an extremely time consuming process to sort out legitimate claims to approve from ones that need to be denied. An employee handling any given claim will need to look through a large pile of submissions across formats, manually log the information into the chosen system and then begin to access the merits of the claim. When the claim is finished, it will be time to start on another one and on it goes. Thankfully, there is technology in place that can enable machine learning in order to not only dramatically shorten this process, but also make it far more accurate and efficient than it has ever been before.

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4 Strategies to Improve Healthcare Claim Review Efficiency by 100% +

Posted by Advent Health Partners on Dec 12, 2017 8:30:00 AM

Medical facilities are busy places with people coming and going at all hours of the day. When all is said and done, each facility could have hundreds— if not thousands— of insurance claims occur each week.

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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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