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Search Results For Articles With This Tag:


"Payers"


Achieving operational excellence through best practices

pointer By Thomas Rekart,

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Reformís new MLR mandates: Challenge or opportunity?

pointer By Eric Demers, September, 2012

Wasteful spending is one of the primary targets of healthcare reform. Defined as costs that can be avoided without....


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Finding buried treasure

pointer By Krista Fuller, June, 2011

U.S. healthcare systems today find themselves in an unenviable position. According to the...


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Revolutionizing the coding and billing cycle with intelligent mobile technology

pointer By Paul Adkison, May, 2011

Using intelligent mobile technology, providers have access via mobile devices to the patient's health...


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The accountable care delivery model

pointer By Charles W. Jarvis, FACHE, May, 2011

Healthcare delivery models are undergoing fundamental transformation, with collaborative-care programs...


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Exceeding expectations for electronic billing

pointer By Scott Law, April, 2011

The past five years have brought a drastic rise in health insurance...


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A code that you can live by

pointer March, 2011

Founded in 1891, OhioHealth is a network of eight not-for-profit hospitals and numerous healthcare organizations serving patients...


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Attach and conquer

pointer By Thomas W. Hughes, February, 2011

Today, the secretary of Health and Human Services has the 275 mandate on her desk, ready to be signed. The question is not if, but when these requirements will be enacted. So what does this mean for healthcare...


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Getting ahead of the reform storm

pointer By Sam Muppalla, January, 2011

The universe of provider information is rapidly expanding and changing across the healthcare ecosystem.


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Electronic referrals and precertifications at your fingertips

pointer By Peggy Denness, November, 2010

Referral and authorization processes are a key part of the day-to-day operations of any primary-care...


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Radiology decisions lead to cost savings

pointer By Stephen Herman, November, 2010

Radiology Decisions Lead to Cost SavingsPoint-of-order clinical decision-support solutions assure that medically appropriate procedures are given the highest priority.

 While research varies, studies report that up to 25 percent of imaging procedures are unnecessary, inappropriate or duplicative. Many health plans have instituted requirements for physicians to provide prior notification or to secure prior authorization. The process is telephone-based and, in many instances, administered by a third-party utilization-management company. In this model, a physician's office places a call to determine if an advanced study, such as an MRI, CT, PET or nuclear cardiology scan, will be covered for a patient's specific situation. Most require a preauthorization code in order to be reimbursed.


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Manage contracts through best practices

pointer By Murali Karamchedu, May, 2010
HMT

Integrated provider management is more than simply managing contractual language. A best-practices approach reaches beyond adherence to preferred legal arrangements.

Traditionally, best practices have meant the examination and enforcement of preferred legal arrangements. Health plans, however, have begun to identify the need for a new strategic framework of best practices in provider contracting that reaches beyond adherence to preferred legal arrangements. This is due to the realization that sole focus on the language of a contract and contract obligations limits a plan's ability to analyze a contract for effectiveness.


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Forecast 2010: Payers

pointer March, 2010

New Momentum for HIT

By Vishal Wanchoo, president and CEO, GE Healthcare IT

Payers

For nearly two decades, healthcare-industry leaders have promoted a nationwide health-information network (NHIN) to help enable clinical-information sharing across multiple institutions and regions. In 2010, there will be unprecedented momentum at the state level to connect health information across providers.

First, the early adopters of health-information networks are showing how sharing clinical information helps drive better clinical decisions, reduce treatment errors and provide a better patient experience. In addition, the ARRA includes $564 million in funding for states to establish health-information exchanges (HIEs). Finally, the maturing of industry standards and the inclusion of HIEs as a part of the meaningful-use criteria is driving state-level adoption. This framework will play a crucial role in eventually achieving connectivity across states, regions and even nations.


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