Claims Processing

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.  

The healthcare industry appears to have successfully withstood the transition from ICD-9 to ICD-10. But are the sighs of relief premature? Is another shoe waiting to drop?

All but seven U.S. states have either passed or are working on legislation that would establish a state-sponsored, all-payer claims database – and that’s among the reasons these databases are in the spotlight for their promise to improve the way providers and insurance companies manage patient populations. This year at the HIMSS16, in fact, John Freedman, MD, president of Freedman Healthcare, and Linda Greene, vice president of Freedman Healthcare, will lead a session intended to shed light on what APCDs are and where they’re headed in the future. See all of our HIMSS16 previews APCDs as “large-scale databases that systematically collect medical claims, pharmacy claims, dental claims (typically, but not always) and eligibility and provider files from private and public payers,” said officials at the Robert Wood Johnson Foundation in a recent report. “States with APCDs are responding to a need for comprehensive, multi-payer data that allows states and other stakeholders to understand the cost, quality, and utilization of health care for their citizens.” “While enormous attention is focused on EHRs and the health record data they contain – deservedly so – the other data world of claims data has been quietly creating applications for public health, price transparency, performance improvement, population health management and health services research,” Freedman said. [Also: 21 awesome photos from past HIMSS conferences] Instances of all-payer claims databases, in fact, have tripled in the past decade. “The impacts of APCDs on healthcare are just starting,” he continued, “and they will be profound.” The session,“Implications of Expanding State All Payer Claims Databases,” will be held on March 3 from 1 - 1:30 p.m. in the Sands Expo Convention Center. Twitter: @HealthITNews This story is part of our ongoing coverage of the HIMSS16 conference. Follow our live blog for real-time updates, and visit Destination HIMSS16 for a full rundown of our reporting from the show. For a selection of some of the best social media posts of the show, visit our Trending at #HIMSS16 hub.

As healthcare and technology professionals gather to share strategies for optimizing revenue cycle management in a challenging and fast-changing reimbursement environment, Healthcare IT News' sister publication Healthcare Finance offers live updates.

Triple-S Management Corporation has agreed to settle potential HIPAA violations with the U.S. Department of Health and Human services to the tune of $3.5 million, after repeatedly failing to put safeguards in place for its beneficiaries' PHI.

AHIMA CEO Lynne Thomas Gordon says she's confident the transition that begins Thursday will go off with few, if any, glitches. As she sees it, all of healthcare will be better for it.

As ICD-10 looms, value-based reimbursement remains clouded in uncertainty and many technology vendors under-deliver on their promises, more and more hospitals are outsourcing their revenue cycle management processes.

We highlight six of the most talked about new products on display and available for demo at the 2015 AHIMA Convention and Exhibit.

They may be in the Big Easy, where the good times roll, but the people in charge of managing health data at hospitals across the country are focused on the hard work of realizing the most benefit they can from ICD-10.