Reduce Manual MIPS Adjustments with SymKey
The 2024 updates to the Merit-based Incentive Payment System (MIPS) significantly impact healthcare professionals, influencing both management practices and compensation for Medicare Part B services. With eligibility criteria encompassing everything from patient volumes to service thresholds, MIPS has set a complex standard that demands precise compliance and operational efficiency. While many Core administrative systems have […]
How SymKey Simplifies Sequestration
Sequestration, a common hurdle for any healthcare payer under Medicare’s Fee-for-Service (FFS) program, often involves tedious manual processes. Let’s delve into this challenge and discover how SymKey frees you from this time-consuming burden. What is Sequestration? Simply put, it’s a federal budget control measure that reduces the amount Medicare pays to providers through mandatory reductions […]
A Closer Look at the Medicare Prescription Drug Inflation Rebate Program
The launch of the Medicare Prescription Drug Inflation Rebate Program is a vital development for the financial and medical well-being of millions of Americans, specifically designed to ease the financial burden of prescription medications for seniors and individuals with disabilities. By instituting an annual out-of-pocket (OOP) cap on drug costs, the program not only alleviates […]
SymKey Unlocks: Simple Solution to Medi-Cal’s Targeted Provider Rate Increase
The recent California Department of Health Care Services (DHCS) amendment to the AB 118 bill has Medi-Cal managed care health plans working overtime implementing this bill. This provision is increasing Medi-Cal rates for eligible contracted providers to equal no less than 87.5% of the lowest Medicare rate who supply treatment for certain Medi-Cal services rendered […]
HCIM Cares: HCIM Leadership Embraces Community Service at the Durham Rescue Mission
North Carolina’s capital, Raleigh, played host to HCIM’s recent Leadership Team Meeting. In the midst of strategic discussions, the team took a meaningful detour to support the local community. Their destination was the Durham Rescue Mission, the oldest homeless shelter in the Durham, Raleigh, and Chapel Hill area. Founded in 1974 with a steadfast mission […]
How a Leading ACO Overcame Systemic Challenges with SymKey
A leading ACO (Accountable Care Organization) and medical group manager faced significant challenges with its claims adjudication processes due to poorly designed auto-adjudication rules. These rules caused continuous claim cycles, creating ongoing issues. Their wide range of operations across rural areas, multiple service organizations (MSOs), and specialized environments, further complicating the situation. Facing the Adjudication […]
Scaling New Heights: The Strategic Advantage of Additional SymKey Robots
When faced with increasing claims volumes or special projects like large-scale reprocessing, many healthcare payers look to traditional solutions such as hiring more staff or mandating overtime for existing staff. Both options come with drawbacks; hiring can be a lengthy process along with significant training investment. Even temporary help requires training and supervision that often […]
SymKey Unlocks: Tackling COB Head-on
The COB Challenge Coordination of Benefits (COB) – the perpetual headache for healthcare payers. Manual processes, incomplete member questionnaires, and the eternal struggle of determining the order of benefits. The result? Delayed payments, increase in appeals such as over payment and under payment of claims, and an increase of claim pend ratio. System Limitations Many […]
Understanding Auto Adjudication
Auto adjudication is the process of swiftly processing insurance and public benefit claims, without the need for manual intervention or decision-making for each claim. In essence, it’s about harnessing the potential of technology and smart system configuration to handle claims automatically. It’s often misconstrued as a straightforward process. Configure certain rules and parameters, set up […]
Exciting New Chapter: HCIM has partnered with Metamora Growth Partners
HCIM is excited to announce as of April 2024 we have partnered with Metamora Growth Partners, marking a significant milestone in our journey. This partnership presents an exciting opportunity for HCIM to enhance our existing offerings and continue providing innovative solutions tailored specifically for healthcare payers. “The drive to serve has been at the heart […]
