Here is a collection of original articles, news stories and blogs that have been put together by our team.

Life Cycle of a Medical Claim

Life Cycle of a Medical Claim Most people believe that a medical claim begins and ends with reimbursement. While reimbursement is undoubtedly a vital component, it is not the only piece in the lifecycle of a medical claim. Understanding and distinguishing the...

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Medical Cost Trends in 2018

PwC’s Health Research Institute has published its annual projection of medical costs in the employer health insurance marketplace. The report identifies the key factors that will impact growth trends in medical costs in 2018. It is expected that the coming year will...

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Common Culprits in Medical Claims Rejections

Common Culprits in Medical Claims Rejections Even the most experienced medical billers make mistakes once in a while. Sometimes insurance companies try to pull a fast one. In either case, every medical practice gets some claims rejected. Here are some of the most...

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7 Insights on progress toward value-based care

A survey of 302 primary care physicians with hospital affiliations and 150 health plan executives examines progress that must still be realized to achieve value-based care. These include achieving better alignment between providers and payers and improvements in electronic health records to bridge critical gaps. Some widely differing views exist between providers and insurers on common issues.

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Audit estimates CMS issued hundreds of millions of dollars’ worth of incorrect EHR incentive payments 

As part of a program to encourage providers to shift to EHRs, the federal government incorrectly paid hundreds of millions of dollars in incentive payments to healthcare professionals who did not actually meet Meaningful Use requirements. The HHS Office of Inspector General estimates that inappropriate payments to eligible professionals totaled $729 million between May 2011 and June 2014.

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Health Care Providers on the Problems of Patient Engagement Design

Better patient engagement is a nearly universal goal for health care providers, but real barriers exist, say health care leaders and clinicians. Nearly two-thirds (63%) of respondents to NEJM Catalyst’s latest Insights Council survey on patient engagement call the time investment required by health teams the biggest challenge in designing patient engagement into care delivery.The underlying issue is reimbursements, says Bertrand Ross, MD, FACC, FACP, Medical Director at Virginia-based Optima Health, a subsidiary of Sentara Healthcare providing health plan coverage to more than 450,000 members. “The problem is that incentives [for patient engagement] are not aligned. The time and effort to educate, motivate, and troubleshoot issues regarding patient engagement are not recompensed very well at present.” Create alignment, he says, and the time investment challenge will disappear.”

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Most healthcare providers don’t know cost of a common ER visit, study says

Researchers have found that an average of only 38 percent of emergency medicine healthcare professionals — including physicians, physician assistants and nurse practitioners — accurately estimated the costs for three common conditions seen in the emergency department. Improving that percentage has the potential to lower costs for patients and the overall healthcare system, according to a study published in The Journal of the American Osteopathic Association.

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