Availity news center

News Center

eHealth Initiative released their final report, The Role of Technology in Value-Based Care & Patient Engagement, which gained insight, from an industry perspective, on the impact of healthcare reimbursement policies on technology and revenue cycle. Twelve executives, primarily from provider organizations and health information networks (HINs), were interviewed for this research project. Analytics were a prominent theme and interviewees felt strongly about the value of data in improving patient outcomes.

Health IT service provider Availity is set to debut a new pre-clearance service this summer that accelerates the process of verifying authorization for imaging exams, and ensures that patients with high deductibles are aware of their financial obligations prior to or upon arrival for procedures.

Data Dimensions, a leader in business process automation, and Availity, the nation’s largest real-time health information network, now offer the workers’ compensation market a new way to connect payers and providers by leveraging Availity’s Provider Engagement Portal as part of Data Dimensions’ Shared Services solution. This multi-payer platform serves as an entry point for providers who require secure access to their payers regarding clinical and administrative transactions.

Thanks to a new relationship with Availity, LLC, Amedisys, Inc, one of the nation’s leading home health, hospice and personal care providers, is processing authorizations more efficiently – and less costly. Previously, Amedisys processed every authorization for managed care claims manually, through either a website or a phone call, requiring 15 to 20 minutes per claim. As a result, authorizations often took too long to complete, thus raising administrative costs and at times, delaying patient care. To address those longstanding challenges, Amedisys forged a relationship with Availity, the nation’s largest real-time health information network. Availity electronically synthesizes and shares data in real-time between providers and health plans nationwide.

Prior authorizations may be as popular among providers as ants at a picnic, but they have become a common and necessary part of the reimbursement process. As a result, being able to manage prior authorizations efficiently is critical to maintaining a healthy revenue cycle and avoiding issues such as denied claims, administrative waste, excessive staff turnover and, of course, patient dissatisfaction.

Prior to the introduction of the electronic health record CMS (Medicare) and other health plan administrators relied upon claims data. Now the mandate of meaningful use has made clinical data available via the electronic health record. Physicians disparage the EHR because of its disruption of the clinical encounter and inefficiency in data entry. Few would deny the enormous data collection which has taken place.

As you are likely aware by now, CMS’ final rule on Emergency Preparedness Requirements for Medicare and Medicaid Providers and Suppliers went into effect on November 15, 2016 and will be implemented on November 15, 2017. This final rule establishes national emergency preparedness requirements for Medicare and Medicaid participating providers and suppliers to plan adequately for both natural and man-made disasters and coordinate with federal, state, tribal, regional, and local emergency preparedness systems.

Administrative costs make up about 15% of all healthcare expenditures—well over $300 billion annually, according to the 2016 index report from the California Association for Healthcare Quality. Outdated, manual processes and rejected claims eat up a large portion of this cost. The key to reducing administrative costs lies in refining these processes and changing with the times, according to industry leaders. Here are five strategies to consider implementing at your organization.

Payers and providers have for decades stayed in their silos, leading to a more fractured and adversarial healthcare system. That relationship, however, is starting to soften for many in the industry. Payer-provider partnerships put the two groups on the same team in hopes of reducing costs and improving care and outcomes through sharing data and better communication.

Although collaboration between payers and providers will be critical if they are to succeed in transitioning to value-based payment models, they continue to struggle with information exchange in the current fee-for-service environment. That’s the finding of a new survey of 40 health plans and more than 400 practice- and facility-based providers, which found significant communication gaps between the stakeholder groups.