Tag Archives: claims management

The journey to value: Preparing for change starts with improved revenue

Cash is king, whether health care organizations like it or not. Moving from volume- to value-based care puts revenue at risk when cash flow is critical. There are three specific areas where organizations can improve revenue: Denials management — Denied claims limit cash flow and negate work already completed. Plus, they add more work for […]
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Ditching MMIS full-system procurement for a “services-only” approach: A quick “how-to” on administrative operations

Adopting a service-based Medicaid Management Information System (MMIS) approach may require that you reorganize some of your administrative operations. For example, you’re probably using your MMIS for capitation payments and the collection of encounter data — but you don’t have to. You can make capitation payments through your finance system and feed your encounter data […]
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Navigating the value transformation journey: Data and analytics to provide actionable information

In a value-based reimbursement setting, your most important technology assets may be your data. That’s because data, coupled with the right analytics capabilities, can help you focus on the patients and the conditions that have the most potential for cost savings and care quality improvement. And isn’t savings and care improvement what this “value transformation […]
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Navigating the value transformation journey: Managing population health yields cost and quality improvement

The premise of value-based contracting is that by changing incentives, health care organizations will help unhealthy people get healthy and healthy people stay that way. The change most value-based organizations are undertaking that stands to make the most difference in the health of patients is population health management (PHM). Population health management is a proactive, […]
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Navigating the value transformation journey: Addressing reimbursement issues head-on

On the journey from volume to value, generating new capital is an important consideration. In the four articles posted so far in this series, everything discussed—patient access management, medical necessity management, and coding and documentation improvement—can help providers  access capital by reducing costs. In this post, we’ll discuss areas in which reimbursement is directly affected.