Healthcare IT Today

MARCH 26, 2024

Healthwise’s operating assets — including content, products, technology, client relationships and certain trademarks — will join WebMD Ignite, WebMD’s market-leading healthcare growth and engagement division serving health organizations, healthcare professionals, providers and payers. and 85% of the top 20 payers.

Electronic Medical Records 97

Electronic Medical Records Hospitals 97

Redox

SEPTEMBER 26, 2023

Top stories CMS creates all-payer model for states CMS is offering an all-payer funding opportunity of up to $12M for eight states to improve population health.

Doctors 105

Doctors 105

Healthcare IT Today

MARCH 29, 2024

With this Series C Funding, Overjet will Expand its AI Platform to Create the First Unified Standard for Dental Providers and Payers — Allowing Them to Give Patients the Best Possible Care Overjet , the world leader in dental AI, today announced a $53.2 dental insurers.

FDA 107

FDA Doctors 107

Medisys Compliance

FEBRUARY 29, 2024

Understanding Virtual Care Billing Codes Familiarizing yourself with the specific billing codes assigned by Medicare and private payers is paramount. Visit Complexity: Utilize different levels within each code category (e.g., secure messaging). 99421, 99422, 99423) to reflect the complexity of the virtual visit. video conferencing).

Medical Billing Outsourcing 59

Medical Billing Outsourcing Informed Consent Medical Billing Medicare 59

Healthcare IT News - Telehealth

APRIL 22, 2024

These codes can be split into two categories to help understand their uses. Numerous commercial payers also cover RPM, sometimes within their telehealth coverage policies. The same is true of any private payers and health plans that modify their coding rules to align with the AMA changes. Medicare was the first to cover RPM.

Medicare 146

Medicare Medicare Medicaid Medicaid 146

Healthcare IT Today

DECEMBER 27, 2023

A recent offering from LexisNexis Risk Solutions promises to greatly expand access to this data, called social determinants of health (SDoH), for payers, clinicians, public health agencies, pharma companies, and other researchers. The data can direct resources in communities to services that address urgent problems.

Public Health 109

Public Health Health Outcomes Doctors Hospitals 109

Healthcare Law Blog

JANUARY 26, 2024

The payers impacted by the Final Rule include Medicare Advantage (“MA”) organizations, state Medicaid and Children’s Health Insurance Program (“CHIP”) agencies, Medicaid and CHIP managed care plans, and plans on the Affordable Care Act exchanges (collectively, “Impacted Payers”).

US Department of Health and Human Services 52

US Department of Health and Human Services Medicare Medicare Medicaid 52

Hall Render

MARCH 20, 2024

CMS recently issued a final rule to require health care payers to improve communications between the payers, providers and patients and to improve the prior authorization processes (“Final Rule”). Additionally, payers are required to respond to Prior Authorization requests within designated timeframes.

Medicare 40

Medicare Medicare Health Insurance Medicaid 40

C&M Health Law

DECEMBER 23, 2022

The regulations impact CMS-regulated payers and provide incentives for providers and hospitals that participate in the Medicare Promoting Interoperability Program and the Merit-based Incentive Payment System (MIPS). iii) Payers would be required to report metrics about the use of Patient Access API.

Medicare 59

Medicare Medicare Medicaid Medicaid 59

Healthcare IT Today

JULY 28, 2023

Verifiable will use this funding to scale go-to-market teams and expand its extensive verifications infrastructure to further differentiate the company’s best-in-category provider credentialing, compliance, and network management solutions. The funding will also further accelerate Verifiable’s collaboration with Salesforce.

Compliance 52

Compliance 52

Health Populi

NOVEMBER 21, 2023

“Businesses which have witnessed a rise in brand value…have all transcended their established category norms and play a more significant and meaningful role in society and consumers’ lives,” we learn in the Interbrand Best Global Brands 2023 report, subtitled, “How Iconic Brands Lead Across Arenas.

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Healthcare IT Today

APRIL 8, 2024

Payers are always wary about funding new treatments for illnesses and conditions: When millions of dollars are at stake, payers want demonstrated improvements in outcomes. ” PHTI justified the exclusion because this expensive form of monitoring isn’t yet covered by many payers (and notably not by Medicaid and Medicare).

Medicaid 92

Medicaid Medicaid Doctors Medicare 92

Health Populi

JUNE 13, 2023

Consumer-facing health-tech categories won’t be spared, we learn in the 2023 U.S. adults 18 and over in April 2023 for this study, exploring 10 technology product categories covering 80+ products. In 2023, U.S. consumers’ purchases of technology in their households will contract this year. million versus 107.9

Health Insurance 62

Health Insurance Hospitals Governance 62

Healthcare IT Today

JULY 30, 2022

Read more… Why KLAS Changed its Patient Outreach Vendor Category. In one of its latest reports, KLAS Research separated Patient Outreach into two new categories , one for administrative patient communication (think appointment reminders) and one more focused on care management.

Nurses 96

Nurses Hospitals 96

Health Populi

MAY 31, 2023

this year — a reduction in trend driven, potentially, by patent expirations on branded drugs and the launch of some biosimilars this year; and, Other services, a broad category covering home healthcare, ambulance services, durable medical equipment, prosthetics, and other items.

Health Insurance 62

Health Insurance COVID-19 Hospitals Governance 62

HIT Consultant

FEBRUARY 9, 2023

. – Impact Advisors tied with Nordic to be a co-winner of the Overall IT Services category. Impact Advisors also excelled in several individual categories, winning Best in KLAS awards for ERP Implementation Leadership, Financial Improvement Consulting, and Security & Privacy Consulting Services.

Nurses 52

Nurses Compliance Hospitals 52

MRO Compliance

MAY 2, 2022

And what about payer revenues for the ROI industry? Here we are 20 years later, and MRO is the second largest ROI vendor in size, and we’ve won Best in KLAS for release of information for the last 9 years in a row, ever since it was a category ranked by KLAS. Why such an increase over 20 years?

Hospitals 130

Hospitals 130

Health Populi

OCTOBER 5, 2020

Power assessed two categories of telehealth vendors: direct-to-consumer (DTC) and payer-provided. Cigna ranked highest among telehealth payer-providers, with payers scoring 865 points in 1,000—higher overall than for DTC players. Power has studied including health insurance, insurance and financial services.

Doctors 141

Doctors COVID-19 Patient Satisfaction Telemedicine 141

Medisys Compliance

JANUARY 28, 2022

Not covered by payer: Medical billing denials for procedures not covered under patients’ current benefit plans can be avoided by checking details in the insurance eligibility response or calling the insurer before administering services. Get a payer response on them, whether in process, paid, rejected, or denied.

Medical Billing 52

Medical Billing Medical Billing Outsourcing Medical Billing Services 52

AIHC

MARCH 28, 2022

Written by: AIHC Blogger This article provides educational information related to fighting unreasonable denials by working through a complex payer appeals process. Audited by a payer? Is your organization under a payer audit? But first, learn more about how a complex payer audit system works. According to the U.S.

Medicare 52

Medicare Medicare Compliance Governance 52

Hall Render

NOVEMBER 29, 2023

This change comes in response to concerns about reporting all payer/all patient data via the APP due to the cost of necessary system-wide infrastructure for data aggregation.

Medicare 40

Medicare Medicare Nurses Payment Systems 40

Healthicity

APRIL 1, 2024

They put them into categories, but we don't really know the details. It's it's known as a biologic, and it often fits into this category of an anti TNF or a TNF blocker. They'll say something like there was not appropriate documentation or, there weren't orders or it was miscoded. But these are kind of generic statements.

Medicare 52

Medicare Medicare Doctors Compliance 52

Healthcare IT Today

NOVEMBER 27, 2023

SafeRide’s scalable and intuitive platform gives payers and health systems a more intelligent way to deliver cost-effective, on-demand transportation that connects health plan members to critical healthcare services. SafeRide serves the country’s largest Medicare Advantage, Medicaid, and provider programs.

Medicaid 83

Medicaid Medicaid Medicare Medicare 83

MedTrainer

APRIL 18, 2024

The process spans various stages, including primary source verification , work history and reference checks, background checks, and payer enrollment, potentially extending up to 150 days. Many payers require providers to maintain a CAQH ProView profile. Get the tools you need to eliminate delays in your provider enrollment process.

Medicare 52

Medicare Medicare Licensing Compliance 52

Medisys Compliance

SEPTEMBER 12, 2022

Payers control much of how and how frequently mental health services are provided. According to some estimates, up to 80% of the amounts owed to mental health practitioners by payers go unclaimed. Mental Health Is Viewed Differently By Payers. A Closer Look. Even minor errors can result in a billing claim being rejected.

Medical Billing Services 98

Medical Billing Services Medical Billing Hospitals Medical Billing Outsourcing 98

HIT Consultant

AUGUST 17, 2021

Founded in 2014, Carrot Health provides consumer insights for each and every individual person in the United States to engage patients and members, close gaps in care, and optimize performance for healthcare payers and provider systems.

Health Analytics 98

Health Analytics Governance 98

HIPAA Journal

AUGUST 8, 2023

There are several categories of workers not covered by OSHA. It is important to note that, regardless of who the payer is, if a temporary worker is assigned a job by a staffing agency, both the employer and staffing agency are accountable for the safety and health of the employee.

Governance 98

Governance Compliance HIPAA Hospitals 98

AIHC

NOVEMBER 29, 2023

A claim would be generated and submitted to the payer. The payer would reimburse the provider according to their FFS contract, which typically had an allowable amount for each billable procedure code. As the cost of providing care grew, payers started instituting methods to curb expenses and how claims were paid.

Medicare 59

Medicare Medicare Medicaid Medicaid 59

AIHC

APRIL 5, 2022

Written by: AIHC Blogger This article provides educational information related to mitigating the risk of an unwarranted payer investigation. Read Part 1 entitled “ Managing Denials Is Important to Good A/R Hygiene ” posted March 22, 2022, and Part 2 entitled “ Understanding How Payers Deny Claims.

Fraud 52

Fraud Compliance Medicare Medicare 52

Healthcare IT Today

SEPTEMBER 29, 2023

Fundraise Supports Market Expansion with Summus Emerging as the Premier Clinical Platform to Share and Access High-Quality Specialty Expertise Across the Continuum of Care — Serving Employers, Payers, Health Systems, and Physician Groups Summus , the leading virtual health company focused on specialty care, announced today that it raised $19.5

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Hall Render

DECEMBER 4, 2023

CMS defined the term standard charges, to include payer-specific negotiated rates/charges, along with gross charges, de-identified minimum and maximum negotiated rates/charges and the discounted cash price, that apply to each item or service. It does not replace the existing requirement.

Hospitals 52

Hospitals Compliance Patient Advocacy Medicare 52

Health Populi

JULY 7, 2020

Among these eight segments, the hottest categories of digital health investment in the first six months of 2020 were on-demand health care (like telehealth and virtual care), monitoring of disease, treatment, and fitness/wellness. Fitness and wellness. Nonclinical workflow. Consumer health information. Research and development catalyst, and.

COVID-19 118

COVID-19 Telemedicine 118

Hall Render

JANUARY 12, 2024

Investors are looking for assets in the following categories: wellness, data centers, affordable housing and other residential assets. McKinsey released its 2024 Payers Outlook. Payers will continue to explore vertical integration by acquiring pharmacies and providers and opening alternative care sites.

Hospitals 40

Hospitals 40

Healthcare IT Today

OCTOBER 26, 2023

For instance, RCxRules’ extensive Hierarchical Condition Category (HCC) content will expand Alpha II’s existing robust rules engine to further elevate coding accuracy. “At RCxRules, our focus has always been helping our customers to succeed and navigate industry challenges,” said Stephen Gorman, CEO at RCxRules.

Compliance 66

Compliance 66

Medisys Compliance

MARCH 29, 2022

A write-off is an amount that a practice deducts from a charge and does not expect to collect, thereby ‘writing it off’ the accounts receivable or list of monies owed them by payers or patients. As per your contract with the payer, every procedure code is assigned a dollar amount called an allowable fee. Contractual write-offs.

Medical Billing 52

Medical Billing Medical Billing Outsourcing Medicare Medicare 52

Healthcare IT Today

DECEMBER 14, 2022

Healthcare IT Today sat down with Keith Florance, Senior Vice President and General Manager of Payers at Clarify Health at the recent #HLTH2022 conference. It is rare that a company will agree to sit down to answer tough questions, but Clarify Health was up for the challenge. Clarify Health.

Doctors 97

Doctors Hospitals 97

AIHC

NOVEMBER 29, 2023

A claim would be generated and submitted to the payer. The payer would reimburse the provider according to their FFS contract, which typically had an allowable amount for each billable procedure code. As the cost of providing care grew, payers started instituting methods to curb expenses and how claims were paid.

Medicare 52

Medicare Medicare Medicaid Medicaid 52