Every year, thousands (yes, thousands) of Medicare, Medicaid, and CHIP (Children’s Health Insurance Program) payments are paid in error. Whether that is through overpayment on a claim, underpayment, duplicate payments,
It’s not as complicated as you might think If there’s one thing that’s been brought to the forefront post-2020, it’s the turnover rate in administrative healthcare positions like claims processors.
At its core, Value-Based Care seems like a no-brainer for the healthcare industry. Simply put, this model rewards providers with incentives based on the quality of the care they provide
In many ways, ICD-10-CM is quite similar to ICD-9-CM. The guidelines, conventions, and rules are very similar. The organization of the codes is also very similar. Anyone who is qualified
No Surprises Act H.R. 133-Consolidated Appropriations Act What is the No Surprises Act? The No Surprises Act provides consumers federal protections against surprise medical billing and limits out-of-network cost sharing
We are pleased to announce the release of SymKey 4.0 for EZ-CAP and PCM with an upgraded Batch Manager interface designed for ease of use. The new functionality provides deeper
By Margaret Cerna, Senior ConsultantHealthCare Information Management, Inc. Responding to COVID-19 requirements Claims processing decision makers are faced with unprecedented challenges and may be evaluating and putting their processes to
Giving back to the communities where we live and work is a cornerstone of the HCIM Culture. During our recent visit to Tampa, Colleagues spent the afternoon at A Kid’s
Robotic Process Automation (RPA) is the technology that allows the software to mimic human actions or interactions and execute business processes. Organizations are facing increased demands on resources, pressuring them
Effective payer provider collaboration is key to reducing the cost of healthcare, and claims management is an integral component of that relationship. As many organizations focus on care management, they
The healthcare payer landscape changes almost daily and it can be hard to see the forest through the proverbial trees. It’s easy to get focused on the day to day
New payment methods, accountable care, consumerism and an increasing demand for effective subscriber engagement and management (which disrupts traditional operating models in the small to mid-sized payer market) are placing
These are challenging times for healthcare payers. Increasing aging populations, pressure to cut costs, and a focus on quality is requiring everyone to do more with less. By facing these
Although the healthcare industry has made some progress in automating claims-related business processes, new findings in the 5th Annual CAQH Index show that widespread adoption of automation processes can result
Accountable care organizations (ACOs) were designed to shift the healthcare industry from the fee-for-service payment model to value-based care, but haven’t always achieved their intended objectives. Based on the successes
