Posts Tagged ‘claims process’

Infographic: When it Comes to Coding, Accuracy Matters

July 11th, 2018 by Melanie Matthews

Medical coding errors are one of the top reasons claims are denied. Denials are expensive to rework, and they can lead to delays in reimbursement—or no payment at all, according to a new infographic by Change Healthcare.

The infographic provides details about the top coding challenges.

Medicare Chronic Care Management Billing: Evidence-Based Workflows to Maximize CCM RevenueSince the January 2015 rollout by CMS of new chronic care management (CCM) codes, many physician practices have been slow to engage in CCM.

Arcturus Healthcare, however, rapidly grasped the potential of CCM to improve patient outcomes while generating care coordination revenue, estimating it could earn up to $100,000 monthly for qualified patients treated in its four physician practices—or $1 million a year.

Medicare Chronic Care Management Billing: Evidence-Based Workflows to Maximize CCM Revenue traces the incorporation of CCM into Arcturus Healthcare’s existing care management efforts for high-risk patients, as well as the bonus that resulted from CCM code adoption: increased engagement and improved relationships with CCM patients.

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Infographic: The Reality of Healthcare Claims Denials

August 12th, 2016 by Melanie Matthews

Some 90 percent of healthcare claims denials are avoidable and two out of three denials are recoverable, according to a new infographic by ZirMed.

The infographic looks at the rates of claims denials, the cost of appealing denials and provides a timeline for working a denial.



Innovative Plan-Provider Ventures: Case Studies From Anthem and AetnaInnovative Plan-Provider Ventures: Case Studies From Anthem and Aetna provides the details of two case studies of plans and providers that are collaborating on value-based care models:

* Vivity, a collaboration between seven prestigious California health systems and Anthem Blue Cross of California, promises to improve quality and share cost savings among the participating entities.

* Innovation Health, the northern Virginia health plan owned 50-50 by Aetna Inc. and Inova Health System, represents a great example of an “alignment” structure, with the new health plan allowing the provider and carrier to tap into each other’s expertise to lower costs, grow market share and move to value-based payment.

Innovative Plan-Provider Ventures: Case Studies From Anthem and Aetna provides strategies to reduce coverage costs and improve outcomes.

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Infographic: Leaks in the Healthcare Claim Process

November 26th, 2013 by Jackie Lyons

In healthcare’s post-reform volume-to-value world, payor reimbursement strategies are tipping in favor of providers who can deliver clinical and financial goods.

However, most practice are leaving up to 30 percent of potential revenue on the table due to insufficient internal resources, processes and technology, according to a new infographic from CareCloud. This infographic shows exactly where physicians are losing money, specifically during the pre- and post-visits, and the visit itself.

Leaks in the Claim Process

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You may also be interested in this related resource: Guide to Value-Based Reimbursement: Profiting from Payment Bundling, PHO Shared Savings, and Pay for Performance.