Tag Archives: coding

Best practices to decrease growing emergency department costs

The costs of services provided by hospital emergency departments have become a source of major concern for payers. When a member receives care at an emergency department (ED), the facility and physicians separately submit evaluation and management (E/M) codes on the claim for services performed. E/M codes are based on services performed while caring for […]
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Unlocking insights and value within health care data through NLP

I recently called natural language processing (NLP) artificial intelligence (AI) with an ROI — and yes, it’s a catchy phrase, but it’s also true. NLP is an essential asset in today’s health care landscape. Let me tell you a story. Bill and Ted work at the same company – Excellent Adventures, Ltd. – but they […]
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Finding the win-win solutions to health care challenges

There isn’t a single cure to address all of the challenges facing our health system, but there is a common goal. We all want a health system that treats patients compassionately, allocates resources efficiently, and provides quality care to those who need it — all without bankrupting ourselves or future generations. Too often we pursue […]
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A critical link between patient engagement and payment resolution

With patient satisfaction scores playing a bigger role in health care providers’ financial bottom lines, hospitals and health systems must pay attention to all interactions with patients, including the billing process. This may require reviewing and updating your revenue cycle. Recently, Becker’s Hospital Review recapped insights from revenue cycle management (RCM) leaders shared over the […]
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Understanding the risks of incomplete medical coding

Information that could affect readmission risks, reimbursement, quality assessments and more is missing from medical records according to a recent study. MedPageToday reported on the study, conducted by researchers at Johns Hopkins University School of Medicine and published in November 2015 in the journal PLOS ONE. The researchers compared two large databases – one based on claims […]
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Documenting diagnoses makes a difference in care quality.

An often-repeated statistic warns that 8 million Americans have diabetes and don’t know it. There are similar claims about other chronic illnesses, like hypertension and chronic heart failure. If a patient doesn’t know they are missing a diagnosis, their health care provider may not either. The white paper Accurate coding: The foundation of accountable care explains that […]
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Optimize performance to accelerate your value-based journey

It’s no secret that health care providers have abundant opportunities to save. Some estimates put the dollar figure in the hundreds of billions in revenue that is lost due to unnecessary expenses, missed income and inefficiencies each year. Executives can play a vital role here in reclaiming these lost resources. You can analyze and pinpoint […]
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The journey to value: From finances to patient access, get your house in order for fee-for-value

Health care is driven by the wants and needs of the market. Consumers want better transparency and value at the same time governments, payers and employers are trying to keep costs down and stimulate quality improvement. This means more pressure on providers to deliver efficient care while not passing on costs to patients. But, making […]
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Trusting predictive analytics

Most likely, the last time you purchased something online you were offered “recommendations” or saw what “others also liked.” The technology behind these common prompts uses predictive analytics. Your online merchant is leveraging data about your shopping and online searching behavior to predict their desired outcome — that you might buy something else! As we […]
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Making the most of health care claims data in value-based care

In my last blog post, I wrote about the need for using clinical data to create a comprehensive data set for analytics. The other side of that equation, however, is using claims data effectively. Providers already can more easily leverage claims data than clinical because of stronger reporting tools and standards, but there are some […]
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