Addressing the Need for Business Process Automation in Healthcare Claims
Those who don’t analyze and improve on the mistakes of the past are doomed to repeat them. This is evidenced by the healthcare industry still being one of the very few industries that, despite the influx of technology available today, is still primarily a paper based industry, requiring some organizations to keep on hand large […]
How to Comply with ACA-Mandated Spending Thresholds
There has always been pressure to “do more with less” and continually reduce operational costs. Labor costs is always one of the largest administrative costs for health plans and managed care payers. I’ve found this to be true in my past positions running health plan operations centers and it continues to be true today. In […]
What is the HIPAA Omnibus Rule and how does it affect me?
In 2013, the Department of Health and Human Services (HHS) strengthened the enforcement of HIPAA and HITECH with the final omnibus rule (omnibus is a Latin term meaning “for everything”). But many covered entities and their business associates do not realize the legal ramifications of this rule. Because some of the largest HIPAA-related breaches that […]
Reduce the Cost of Processing Healthcare Claims through Automation Technology
The December 2014 “State of the Payor” industry survey compiled responses from over 120 leaders from health plans across the United States. They found that over 88% of those surveyed are currently using or plan to use technology as the catalyst to transform their organization this year. More than 87% stated that stricter requirements resulting […]
A Race to the ICD-10 Finish Line
With less than 8 months until the mandated October 1, 2015, ICD-10 implementation deadline, it is now a race to the finish line for many small to mid-sized health plans and providers. While there is a very small minority that think there will be another delay, CMS and Congress have constantly reiterated that the ICD-10 […]
CMS Announces Technical Issue that Delays Medicare Physician Fee Schedule until 1/15/15
Hold your claims! When CMS has an issue, we all have an issue. The Medicare Physician Fee Schedule that was published in the Federal Register this past November has been cancelled by CMS for correction of unspecified errors. MACs will hold claims until at least January 15, 2015 due to revisions to the conversion factor […]
Why should the U.S. move from ICD-9 to ICD-10?
Carl Natale wrote today in his article “ICD-10 Data: Why U.S. healthcare needs to move on from ICD-9 coding” that while many opponents of ICD-10 say that it won’t improve patient care, the fact is that it will – just not right away. Compiling enough data to make a significant difference can take years, but […]
What do the Midterms Mean for Obamacare?
In the aftermath of the 2014 midterm elections where Republicans gained control of the Senate and maintained control of the House, America is wondering what all this means for the Affordable Care Act. Junior Republican Senator Ted Cruz of Texas had already vowed to dismantle Obamacare once Republicans secured both chambers of Congress, but is […]
HCIM and PCG Software Announce Partnership to Reduce the Cost of Healthcare for Payers and Other Managed Care Organizations
HCIM to Serve as the Exclusive Value-Added Reseller for PCG Software’s Virtual Examiner® and Virtual Reporter® HCIM and PCG Software, Inc. (PCG) today announced an exclusive value-added reseller (VAR) agreement to resell PCG’s Virtual Examiner® and Virtual Reporter® (VE/VR) claims recommendation software to the healthcare payer/managed care industry. With the use of more than 30 […]
4 Reasons Why ICD-10 Won’t Be Delayed Again
Since the last newsletter, the ICD-10 deadline was delayed by Congress to a “no sooner than” Oct. 1, 2015 compliance date. This news was incredibly disappointing to many in this industry, especially those who had already invested a significant amount of resources to comply with the ICD-10 mandate. As this was the fourth delay of […]