CEO Insight: Healthcare Trends to Watch

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 and miss important trends that may have significant impact down the road. As we look to the future, it’s important to keep these key trends […]

Core System Replacement Considerations for Healthcare Payers

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 enormous pressure on providers to innovate and improve operational efficiency. Outdated core legacy systems may hinder a payer’s ability to respond rapidly to this evolving […]

CEO Insight: Obstacle or Opportunity? Three hurdles facing healthcare payers

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 challenges head-on, we can turn these obstacles into opportunity. It is through continued innovation and experimentation that we will improve health care delivery in this […]

Automation can help commercial healthcare payers and providers save over $11 billion annually

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 in huge cost savings. The index suggests that full adoption of electronic transactions in the healthcare industry will result in potential savings of over $11 […]

Understanding the Next Generation ACO Model

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 and limitations of the Medicare Shared Savings Program (MSSP) and the Pioneer ACO Model, CMS launched the Next Generation ACO (NGACO) Model in 2016 to […]

What you need to know about miscalculated 2019 MIPS payment adjustments

If you are one of the over 418,000 Medicare providers who participated in the 2017 MIPS reporting period, you may want to take a second look at your final score. CMS recently shared an important update announcing the extended deadline for clinicians, groups, and APM entities to review their performance feedback. Now you will have […]

What is the Health Insurance Providers Fee and Who Pays It?

To offset the growing number of uninsured Americans, Congress enacted the Affordable Care Act (ACA) in 2010. With it came provision 9010, establishing the Health Insurance Providers (HIP) fee, a tax that is placed on covered entities that provide health insurance. The intention of this fee was to help fund state marketplaces and exchanges, and […]

ICD-11 Digitizes Global Healthcare Coding Practices

The purpose underlying the International Classification of Diseases (ICD) manuals is to establish a common language to organize and identify diseases and their impacts on human lives. The recent release of ICD-11 promises to further enhance the understanding and control of global diseases. Transitioning to ICD-11 isn’t required until 2022, but medical coders will want […]

4 Factors Driving Rising Healthcare Insurance Premiums in 2019

Did you know that health insurance companies are already at work setting their premiums for 2019? This year, that endeavor may be more challenging than in previous years; politics, evolving medical costs and actions by independent states are all contributing to the rise of healthcare insurance premiums. Key drivers for premium changes According to the […]