Health plans and payers recognize the profound importance of social determinants of health in managing the overall health of a population. These issues first began to surface in case management programs, as nurse case managers were speaking with patients and...
What is HCC Coding? In medical terms, Hierarchical Condition Category (HCC) coding is a common non-proprietary system used by the Centers for Medicare & Medicaid Services (CMS) for Medicare Advantage and the Comprehensive Primary Care Plus (CPC+) program. Medical...
The relationship between physician practices and health plans is complicated. Each party has its own priorities and agendas to remain financially viable, and sometimes those priorities conflict. Yet health plans and physicians are inherently dependent on each other...
Private health plans as well as Medicare and Medicaid have used risk adjustment for years to evaluate the health outcomes and costs for treating their enrollees. Risk adjustment is an equalizer. It is designed to ensure that health care providers and health plans are...
One of the best ways to maximize revenue under value-based care arrangements is for health plans and physicians to team up and work collaboratively on health care transformation. By building a strong and meaningful partnership, health plans and physicians can achieve...
Real World Perspective from a Practice Transformation Coach If you are working in the health care industry, outside of providing direct patient care, it is easy to believe that we are in the thick of value-based reimbursement. You hear about the concept everywhere,...
Health plans have a lot at stake in this value-based market. Purchasers, including large employer groups, and government programs, such as Medicare and Medicaid, are demanding higher quality and more value. Quality improvement and HEDIS results are at...
When it comes to population health management, having access to the right data is critical. Yet, health care providers and payers often find the variety, volume, and complexity of health care data is a major barrier to delivering efficient and high-quality care. The...
With the increase in medical insurance plans with high deductibles, most medical practices have a significant amount of patient accounts receivables. Practices send statements monthly but do not see the return on investment based on the amount of money it costs to...
Resolving insurance claim denials can be a time-consuming process that often gets placed at the bottom of the to-do list. Below are two common claim denials, how to resolve them, and how to avoid them in the future. 2 Common Insurance Claim Denials Patient not...
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