Claims Processing

McKesson expands its ability to support customers in bundled payment programs with HealthQX’s ClarityQx software.

New rules under MACRA mean that qualified providers can share or sell analyses of Medicare and private claims data, which the Centers for Medicare and Medicaid Services could be a boon to better care delivery.

Payers reject 6.4 percent of claims on the first go-round, company data show.

While EHR implementations can be disruptive, the hospital system implemented new clinical and revenue cycle software in January and is pointing to its strategy of engaging every employee in the electronic health records system deployment.

The platform will enable payments to be processed faster, reduce risk for hospitals transitioning to value-based care and ultimately decrease the cost of bundled procedures, the companies said. 

The collaboration aims to help health plans more easily scale both fee-for-service and value-based models.

The health system credits clinical and financial improvements to a CDI initiative that resulted in more accurate coding and greater physician engagement. 

Revenue cycle management has gone from being a "back office" function to an "end-to-end" system that begins at patient intake or even before, claims specialists say.

Advanced analytics and machine learning technologies are critical to pinpointing problems in large datasets that could be losing providers money. That’s why some organizations are investigating every single denied claim to better understand trends. 

Hospitals are starting to hire younger, more diverse people to handle the new coding. The shift will likely benefit healthcare organizations in time, but it won’t happen overnight.