Claims Management


The Key Steps Towards ICD-10 Readiness

Regardless of the calls for the ICD-10 compliance date to be delayed once more, those who take the risk of being unprepared come Oct. 1 of 2015 could end up in trouble. Amongst the uncertainty, there are still opportunities to continue toward ICD-10 readiness. The key here is that all healthcare players need to be […] Read More

HIPAA Concerns for 2015

Healthcare stakeholders are about to face a new frontier in the battle to remain HIPAA compliant and protect PHI and health data – digital. The new digital healthcare landscape is one of the key concerns for payers, providers, and patients as we enter into 2015 and have the opportunity to look back at 2014. Since […] Read More

Next Steps for HIPAA in Fighting Data Breaches

The HHS recently faced two HIPAA compliancy settlements that have given arise to questions surrounding the sufficiency of the current provisions surrounding data breaches. As the healthcare landscape rapidly evolved in the last 5 years, the governing regulations over data security, data privacy, and cyber security still lack the required measures of protection. The recent […] Read More
Medical Debt

Tackling Medical Debt

The current state of medical debt across the US has begun to prompt providers to consider alternate action when attempting to collect unpaid medical bills. Currently, more than 50% of patients will struggle to pay medical debt this year, according to the Patient Advocate Foundation (PAF), a non-profit organization that provides patients with chronic, debilitating […] Read More
Healthcare Price Transparency

HCCI Launches Healthcare Price Transparency Portal

Three major health insurance players – Aetna, Humana, and UnitedHealthcare – have teamed up with the non-profit Health Care Cost Institute (HCCI) to launch an online portal where they will publish information on their healthcare prices. Scheduled to go live in early 2015, HCCI “expects additional carriers to participate in the near future” as many […] Read More
Diagnostic Imaging

Diagnostic Imaging Cost-Containment Strategies

For most complex medical procedures, some form of diagnostic imaging is often conducted prior to administering treatment. Currently, diagnostic imaging is amongst the fasting rising area of medical expense, increasing almost twice the rate of prescription drugs at 20% growth. Almost $100 billion is spent on imaging in the US annually. Factor in its growth […] Read More
cost plus methodology

Hidden Surcharges Calculator For Healthcare Payers

For healthcare payers and patients, value for money remains a key driver in selecting medical providers and treatments. Value plays an even bigger role for employers whom sponsor their employees’ health insurance plans.  Recently, our friends at The LeapFrog Group developed a tool that aims at helping payers – specifically employers – identify the hidden […] Read More

ICD-10: Providers & Payers – Be Prepared

As of October 2014, the latest version of the International Classification of Diseases – ICD-10 – will take effect, requiring healthcare professionals to implement a series of complex and in depth changes to their medical coding process and compliancy. ICD-10 will increase the current code database under ICD-9 from 17,000 procedure codes to 141,000. Prior […] Read More

The Claims Management Experience

PayerFusion: Building The Claims Management Experience When PayerFusion’s claims management department receives a claim from one of the providers in its network or an affiliated insurer, the ball gets rolling fairly quickly. While claims arrive from all over the globe, some simple, some complex, our claims management team will always ensure the fairest price is […] Read More
Medical Claims Fraud PayerFusion

Medical Claims Fraud: More to be earned than lost.

With the healthcare industry concentrating on distribution and accessibility, serious financial and administration matters are being overlooked. Medical Claims Fraud is an area where there is a need to improve regulating efforts and a potential to recover billions of lost dollars. By taking a closer look at the issue, analyzing the effectiveness of the False […] Read More
healthcare waste overuse misuse abuse

Overuse, Underuse & Misuse: 3 Types of Inappropriate Care Leading to Healthcare Waste

$740 billion- this is the amount of estimated waste in the US healthcare system. Most would agree that controlling healthcare costs and improving quality will only be possible by reducing this astonishing amount of waste. Read More
case management explained

Medical Case Management Explained

The 2009 CMSA approved definition of Case Management is a collaborative process of assessment, planning, facilitation, care coordination, evaluation and advocacy for options Read More