Is Core System replacement really the best option? What Healthcare Payers need to know before they take the leap.
The only constant in healthcare is change. The landscape is constantly evolving, and all the players are feeling the heat to improve care delivery while making healthcare more affordable. There are many factors at play here; new payment methods, regulatory changes, and the need for better engagement and management of the health of members can […]
HCIM Cares: 2022 ACM Giveback at Eddy House
Northern Nevada’s homeless, at-risk, aged-out foster youth is on the rise. A single night on the streets of Reno alone can claim up to 205 homeless youth under the age of 25 according to the 2020 Annual Homeless Assessment Report (AHAR). Young and afraid, they survive with nowhere to, barely getting their basic needs met. […]
Prior Authorization Reforms: Navigating the Road Ahead
Prior authorization has been a topic of contention ever since the strategy was proposed. While it certainly has benefits for healthcare payers, providers have been pressing CMS for reforms, and rightfully so. Prior authorization is a process in healthcare where providers ask payers for permission to provide a prescribed procedure, service, or medication before they […]
SDOH and Health Equity in 2023
If you’ve been keeping up with The Center for Medicare and Medicaid Innovation, or are employed by a health system, then you’ve likely seen the federal government’s new requirements in its ACO REACH payment model. The new data collection requirement tells us that 2023 will be the year for walking the walk as far as […]
CMS Changes Affecting ACOs in 2023
As the healthcare industry continues to evolve, so do the technologies and systems used to manage and deliver care. In 2023, CMS (Centers for Medicare & Medicaid Services) will be implementing changes that will have a significant impact on ACOs (Accountable Care Organizations). Overall, these changes are designed to support the growth and success of […]
Problematic Telehealth Claims
Ten years ago, telehealth and telemedicine barely existed. Sure, you might have gotten a call from your doctor or pharmacist for small things, but as far as healthcare is concerned, most visits were completed in-office. Telehealth has taken the world by storm in recent years, providing access to healthcare even for remote patient populations. The […]
Rising Denial Rates: Was it COVID or Human Error?
If you’ve looked at claim denial data from 2020, you know that in-network claim denial rates were at an all time high. There are a lot of variables that go into approving or denying medical claims, and many of the processes are manual or conducted by humans. Why does that matter? Some may blame the […]
How Provider Data Affects Payers and Why You Should Care
Data management has been a huge topic of conversation lately, especially Provider data. To many, Provider data feels like it should stay a provider problem, the truth is that it affects healthcare payers in a significant way. Inaccurate or disorganized data can result in negative outcomes for patients and severe financial challenges for health plans. […]
HCIM Cares: Serving Los Angeles’s Most Vulnerable Population
Los Angeles is known for many things: the glittering lights, star-studded neighborhoods, unique culture, and Rodeo Drive. The last place that people think of when visiting Los Angeles is Skid Row. Skid Row is a 54-block area of downtown Los Angeles where poverty abounds, and homelessness is the status quo. This area is largely avoided […]
HCFAC Report: FY21 Healthcare Fraud
If you are in healthcare, you’ve likely heard of the recently released Annual Report of the Departments of Health and Human Services and Justice. The Health Care Fraud and Abuse Control Program had a lot to report for the 2021 fiscal year, and the results were fascinating but not surprising. After the onset of the […]
