Availity Blog

Availity Blog

Actionable insights for medical business professionals

If you’re a healthcare provider still processing most claims manually, you know first-hand the challenges this presents. First, you deal with a lot of paper—from spreadsheets to claims forms to sticky notes— just to keep track of what you billed, what got paid, and what got denied. Second, you spend a lot of time communicating with the payers to track down claims, follow up on payments, and reissue remittances. Automating these processes sounds good, but what kind of results can you really expect?

In the first episode of Bill’s journey, you saw how Bill’s new primary care physician and a specialist worked together to exchange information and coordinate care, saving everyone money and improving Bill’s health.

Join us Friday, 5/12 at 1pm ET for our #AskAvaility tweetchat on Provider Front-End Workflows where our VP of Authorizations, Mohammed Ahmed (@elpmma) and the Master of Workflow, Charles Webster (@wareFLO), will discuss how providers can streamline their front-end processes to stay current in an increasingly competitive industry and increase revenue.

What’s it like to navigate the healthcare system as a patient? In Availity’s new three-part video series, Bill’s Journey, you can see firsthand how the relationship between health plans and healthcare providers affects his care.

Is your revenue at risk? If your hospital or practice isn’t fully adhering to the risk adjustment and Hierarchical Condition Category (HCC) coding requirements for Medicare Advantage (and some Medicaid) plans, the answer may be yes. Many healthcare organizations underestimate what’s required for these plans and it’s costing them money.

A recent report by CAQH demonstrated that outdated, time-consuming manual processes are still being utilized to exchange information between insurers and providers, particularly financial and administrative data, and it costs us all a fortune. What can we do about this waste? CAQH CORE is a non-profit that brings entities across the healthcare industry together to encourage automation by promoting a common set of rules and underlying standards governing electronic data exchange. To highlight which entities are meeting – or exceeding – these rules and standards, CAQH CORE has developed a certification program.

Join us Friday, 4/14 at 1pm ET for our Assessing Quality Measures tweetchat featuring our own Risk Queen, Susan Bellile (@SKB_RnQ), and The Healthcare IT Guy, Shahid Shah (@ShahidNShah), as we discuss the current and future role of quality measures through technology, legislation, and innovation.

“How well does this vendor integrate with Epic?” It’s an increasingly important question among hospitals and health systems that run Epic and are considering a new claims and clearinghouse solution. It was one of the questions Community Health Network—a non-profit health system with more than 200 sites of care throughout Central Indiana—asked as it sought to consolidate the number of revenue cycle solutions in use across the organization.

Any successful company recognizes the importance of customer touchpoints—those critical moments when a customer engages with someone in the organization. “With the rise of consumerism, healthcare organizations are no different,” says Sarah Holt, a nationally known author and healthcare management consultant. Holt believes that for too long hospitals and physician practices haven’t focused enough on business operations, assuming clinical expertise would make up for any shortcomings.