Tag: Revenue Cycle Management

Retrieving Billions in Overpayments by CMS

Retrieving Billions in Overpayments by CMS

Healthcare IT Today

Amid swirling accusations that Medicare Advantage Organizations (MAOs) are overbilling the U.S. government and calls for better oversight, the Centers for Medicare & Medicaid Services announced in early February that it would investigate overbilling by those plans. They expect to recoup 4.7 billion dollars through this program.
This article focuses on the relatively young technologies that enable CMS to uncover overbillings, whether they be errors or fraud. The article is based on an interview with Kel Pults, chief clinical officer and vice president of MediQuant. A future article will explain how Medicare Advantage plans are trying to improving data collection and reporting,…

Continue Reading

Experian Health Launches AI-Driven Predictive Denials Management

HIT Consultant

What You Should Know:– Experian Health launches a new AI-Powered solution, AI Advantage that will help providers recoup the billions in lost dollars due to insurance claim denials. – These new solutions leverage AI and help healthcare providers prioritize their claims reimbursement process and decrease denials overall, saving time and money across the entire healthcare value chain and ultimately improving care and service for patient consumers.AI Advantage[embedded content]One of the top contributors to wasted healthcare dollars is due to the claims process, reported at more than $250 billion per year. Additionally, 35 percent of hospitals and health systems report $50 million or more in…

Continue Reading
Readers Write: Faster Horses? Let’s Think Different

Readers Write: Faster Horses? Let’s Think Different

HIStalk

Faster Horses? Let’s Think Different By Stuart Hanson
Stuart Hanson, MBA is CEO of Avaneer Health of Chicago, IL.

American industrialist and business magnate Henry Ford is purported to have said, “If I had asked people what they wanted, they would have said faster horses.” The same could be said when it comes to what it’s going to take to transform the US healthcare system, one of the most administratively complex in the world.
When compared to other high-income nations, we spend the most, yet have poorer outcomes. While we have many initiatives in place to fix our current administrative…

Continue Reading
Transforming Medical Coding and Billing Processes with Artificial Intelligence

Transforming Medical Coding and Billing Processes with Artificial Intelligence

The Healthcare Guys

Providers and Payers would be familiar with a situation where their medical coders struggle to proceed when there is more than one way to code a particular medical diagnosis and treatment.
The latest revision of WHO’s International Classification of Diseases ICD-11 contains 17,000 unique codes and more than 120,0000 codable terms yielding +1.6 million clinical situations! Searching for the most appropriate ICD code and mapping the available medical data accurately is one of the biggest challenges the healthcare system faces today.
Unstructured medical data is another perennial challenge. About 80% of medical data remains unstructured according to an NCBI journal. Extracting…

Continue Reading
Top EHR Vendors 2023 – Epic, Cerner, Meditech, Allscripts/Veradigm

Top EHR Vendors 2023 – Epic, Cerner, Meditech, Allscripts/Veradigm

Healthcare IT Skills

Here is where we will explore the top EHR vendors, focusing on those who specialize in either enterprise wide systems, or electronic health records for physician practice offices. Since one of the goals of this site is to help people who are starting in healthcare IT, I’ve tried to find out if the vendors have intern or apprenticeship programs.There are many more vendors in specialty areas, such as lab, pharmacy, materials management, consulting, and medical devices that can be found on this resource of healthcare IT companies.
Allscripts (Veradigm)
Allscripts is a publicly traded provider of practice management, EHR and financial management systems…

Continue Reading