Claims Processing

Claims processing involves both healthcare payers and providers, and relies heavily on the use of IT systems to submit, receive and either approve or deny payment. Disrupted processing can subject providers to cost increases associated with inefficiency and outstanding balances. Hospital billing departments use billing and revenue cycle management systems to get claims processed and paid in the most timely and efficient manner possible.

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Nine hospitals in seven states to pay $9.4M to resolve False Claims Act allegations
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With Medicare's "two midnight rule" set to take effect later this year and audit appeals facing lengthy backlogs, the Recovery Audit Contractor program may be headed in some new directions.
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Post date: April 1, 2014
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When it comes to patient collections at small, community hospitals, the process can be much the same as at larger hospitals around the country, with one exception.
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Post date: March 25, 2014
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An unusual 90-day grace period for government-subsidized health plans may leave physicians at risk for not getting paid for their services.
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Post date: March 20, 2014
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The financial impact of the two midnights rule remains an open question and so is whether recovery auditors will challenge fewer claims or just shift their focus.
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Post date: March 17, 2014
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Despite the hassle of auto-cancellations, many home healthcare agencies find it difficult to keep track of their requests for anticipated payment.
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Post date: March 11, 2014
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Although highly touted, the patient-centered medical home model failed to lower use of services or total costs and produced little quality improvement over three years, research in the latest Journal of the American Medical Association has found.
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Post date: February 26, 2014
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With the threat of significant reimbursement losses, hospitals and health systems are feeling the pressure of getting the transition to ICD-10 right.
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Post date: February 25, 2014
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Abbott Laboratories has agreed to pay the United States $5.475 million to resolve allegations that the company violated the False Claims Act by paying improper kickbacks to induce doctors to use some of its products.
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Post date: December 31, 2013
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Administrative errors resulting from adjusting to new policies has led to an increase in the improper payment rate for Medicare, the Department of Health and Human Services disclosed in its annual financial report.
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Post date: December 30, 2013
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In the revenue cycle management market, hospitals show high adoption of technology focused on eligibility and scheduling, with much work left to be done around charity screening and propensity to pay, according to a new report from HIMSS Analytics.
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Post date: October 21, 2013
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Improving care and lowering costs for beneficiaries eligible for both Medicare and Medicaid is the holy grail of the government and health plans alike.
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Post date: October 20, 2013
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S&P Dow Jones Indices has launched a new indicator that measures claims data from 33 health insurance companies and other organizations to calculate the growth in commercial healthcare costs.
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Post date: October 3, 2013
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It has never been clearer: physician practices must be able to code in ICD-10 to bill for services and procedures after Oct. 1, 2014, or they will see a cash flow interruption, additional costs and delayed claims payments. But payers, clearinghouses and vendors can help you.
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Post date: March 11, 2014
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There's still plenty of work to do before the Oct. 1 ICD-10 deadline. A recent study found that only 4.8 percent of physician practices reported significant progress in overall ICD-10 readiness. Hospitals report higher levels, but many are still behind.
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Post date: March 3, 2014
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Healthcare is one of the last bastions of consumer-unfriendly billing and pricing. As individuals start to take on more responsibility for premiums, deductibles and co-pays, they are increasingly demanding more transparency. And providers will be forced to respond.
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Post date: February 27, 2014
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Conventional wisdom says that too many ICD-10 codes will make it harder for clinicians and medical coders to do their jobs. Some studies suggest a 50 percent or more drop in productivity. But is this an underestimation of the problem?
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Post date: February 17, 2014
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A disconnect occurring in the fraud identification process used by CMS could mean that legitimate claims may be flagged as possible fraud.
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Post date: January 28, 2014
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If you haven't figured out an ICD-10 transition budget yet, it may be too late. But it's a good idea to get a handle on what it will cost you. Better late then never.
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Post date: January 16, 2014
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While the past year was relatively tame regarding ICD-10, at least in regard to the mad scramble some expect leading up to October 1, 2014, there were some significant developments.
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Post date: December 30, 2013
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I don't mean to pick on healthcare IT vendors, but they're going to be in for some tough criticism in 2014, according to the results of a Workgroup for Electronic Data Interchange ICD-10 survey.
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Post date: December 26, 2013
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"This is only a test" is one of those phrases meant to put people at ease. But when it comes to ICD-10 testing, maybe healthcare providers shouldn't be at ease.
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Post date: November 20, 2013
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If hospitals and health systems do not get buy-in from their physicians, the ICD-10 transition may be hazardous to the health of the organization. Here are five tactics that will help.
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Post date: November 6, 2013
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One of California's largest health systems is paying $46 million to settle allegations of overcharging payers with obscured anesthesia billing practices. The state's insurance commissioner calls the agreement "groundbreaking."
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Post date: November 5, 2013
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For the most part, the largest U.S. healthcare providers have been very organized and prepared for ICD-10 implementation. Is there anything we can learn from their experience?
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Post date: October 14, 2013
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