Hayes' Healthcare Blog

Insurance carrier setup neglect: a costly oversight - Part 2 of 2

Posted by Angela Hunsberger on March 2, 2016 at 9:00 AM

In last week’s blog Angela Hunsberger outlined the importance of cleaning up the insurance carrier list to ensure efficiency to maximize payor reimbursement.  More than consolidating an old list, she explained the nuances of paper vs. electronic claim submission and suggested partnering with the billing team to tackle the list.

Continued in Part 2 of a two piece post, Angela provides an instructional roadmap detailing six steps of insurance carrier cleanup.   This article will provide the knowledge and tools needed to revamp carrier settings and revel in the financial payoff of a job well done.

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Topics: revenue cycle management, electronic healthcare information, Healthcare insurance

Insurance carrier setup neglect: a costly oversight - Part 1 of 2

Posted by Angela Hunsberger on February 24, 2016 at 9:00 AM

Insurance submission and processing has evolved over the past decade transitioning from printing paper claim forms to an electronic workflow. Adaptations include the NPI implementation, using a new standard paper claim form, sending more electronic claims as payors offer connections (or even refuse paper claims), moving to the ANSI 5010 electronic claim submission format, and most recently transitioning to ICD10. Considering those changes, along with the flurry of your other projects, have you audited your insurance carrier setup lately to ensure it is configured to maximize revenue cycle efficiency? By efficiency, I am referring to leveraging technology you are already paying for to get the most bang for your buck and maximize payor reimbursement.

Some people may think cleaning up the carrier list is a grueling meaningless chore and a waste of valuable time. On the contrary, the payoff is quick and it’s in real dollars and cents so you will want to reap the benefits by tackling the list at full speed. The outcome is not simply to consolidate an old insurance carrier list; it is much more dynamic than that. This blog, the first part of a two piece post, will explain what to look for and why. Read on my friend.

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Topics: revenue cycle management, electronic healthcare information, Healthcare insurance

Healthcare Leaders Blog: Data, Analytics, and the Emerging Role of the CMIO, Gregory Ator, MD., CMIO

Posted by Gregory Ator, M.D., CMIO on September 16, 2015 at 9:00 AM

Data, Analytics, and the Emerging Role of the CMIO

By Gregory Ator, MD., CMIO, of the University of Kansas Hospital (Kansas City), University of Kansas Physicians Inc.

The role of data and analytics in healthcare especially as it relates to transparency has been discussed widely. What is your view of how data and analytics has changed and will continue to change the way healthcare is delivered?

It is well known that healthcare is moving from volume to value - value defined as optimal outcomes for the least cost. And with some urgency, many organizations are trying to figure out how to successfully navigate this transition. At the crux of this shift, is the availability of data. Data is crucial because you can’t achieve optimal quality and outcomes without it. Accurate clinician documentation in the EMR is more important than ever because this is what generates process improvement data points, hopefully, as a by-product of the care process. In order for all this to work, improved clinician-friendly EMR functionality is desperately needed.

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Topics: data, healthcare EMR, Data analytics, thought leadership, healthcare leaders, advice, electronic healthcare information, patient experience, CMIO, Healthcare Analytics, Hayes Thought Leadership Blog Series

What Closing the HIPAA Gaps Means for the Future of Healthcare Privacy, Kirk J. Nahra

Posted by Kirk J. Nahra on July 29, 2015 at 9:00 AM

 

What Closing the HIPAA Gaps Means for the Future of Healthcare Privacy

By Kirk J Nahra, Partner and Chair of Privacy and Data Security Practice at Wiley Rein, LLP.

By now, most people have felt the effects of the HIPAA Privacy Rule (from the Health Insurance Portability and Accountability Act). HIPAA has set the primary standard for the privacy of healthcare information in the United States since the rule went into effect in 2003. It’s an important rule that creates significant baseline privacy protections for healthcare information across the country.

Yet, from the beginning, important gaps have existed in HIPAA – the most significant involving its “scope.” The rule was driven by congressional decisions having little to do with privacy, but focused more on the portability of health insurance coverage and the transmission of standardized electronic transactions.

Because of the way the HIPAA law was crafted, the U.S. Department of Health and Human Services (HHS) could only write a privacy rule focused on HIPAA “covered entities” like healthcare providers and health insurers. This left certain segments of related industries that regularly use or create healthcare information—such as life insurers or workers compensation carriers— beyond the reach of the HIPAA rules. Therefore, the HIPAA has always had a limited scope that did not provide full protection for all medical privacy.

So why do we care about this now?

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Topics: HIPAA, healthcare privacy and security, healthcare leaders, electronic healthcare information, insurance, Hayes Thought Leadership Blog Series

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