Availity news center

News Center

Mark Martin, Director, Payer and Vendor Portfolio at Availity, the nation’s largest real-time health information network, will take part in a panel discussion titled “Solving the Inaccuracy and Inadequacy of Provider Directories” at WEDI 2017, May 15-18, in Los Angeles.

In an era of shrinking reimbursements, it's more important to capture every dollar owed to your practice as far forward in the process as possible. It's a matter of time and money. According to a 2016 Kaiser Family Foundation study, average deductible and co-insurance costs have seen the biggest increases between 2004 and 2014, and continue to grow while copays are continuing to decline. The shift toward high deductible health plans has fueled that rise.

Availity, the nation’s largest real-time health information network, announced the launch of its automated prior authorization platform, which eliminates the cost, time, and administrative burdens associated with manual authorization processes.

A myriad of factors stand in the way of health care organizations using data analytics to boost reimbursement. As hospitals transition to a value-based reimbursement model, data analytics may play a leading role. However, with an overwhelming wealth of information being generated each day, key decisions must be made to ensure the captured data are truly of benefit.

The Centers for Medicare & Medicaid Services (CMS) released a report in January on the accuracy of provider directories, the online lists provided by insurers and used by health plan enrollees to find in-network doctors or select a plan in which their preferred caregiver participates.

For health insurance companies, an accurate, easy-to-update standardized database for network provider data is the Holy Grail. Along with being a major source of frustration for members, inaccurate provider information negatively impacts claims processing, provider credentialing and the ability to ensure compliance with network adequacy rules. It also can create obstacles for providers that want to create a value-based benefit approach.

In a time of healthcare consumerism and high-deductible health plans, the patient has become a major revenue source for healthcare organizations. But without strong point-of-service patient collection strategies, providers could be seeing their payments walk right out the door with their patients.

Health plans have long supplied their members with provider directories to assist in finding in-network physicians who are accepting new patients. But what should be a helpful aid often isn't, due to outdated or just plain wrong data. Not only is this frustrating for patients trying to find an available provider, it can cost them more than they anticipated if they end up incurring out-of-network fees for a physician they thought was in-network.

A tiny change to how a small hospital uses technology is resulting in big savings of between $3,000 and $10,000 a month. Iroquois Memorial Hospital, a 25-bed facility in the eastern Illinois town of Watseka faced a problem.

As patient financial responsibility continues to increase in a more consumer-focused healthcare environment, more hospitals are shifting healthcare revenue cycle management strategies to improve patient collections. Iroquois Memorial Hospital in Illinois is one of these healthcare organizations.