Availity Blog

Availity Blog

Actionable insights for medical business professionals

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A recent report by CAQH demonstrated that outdated, time-consuming manual processes are still being utilized to exchange information between insurers and providers, particularly financial and administrative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.

Last year, Availity, the nation’s largest real-time health information network, participated in a pilot initiative with America's Health Insurance Plans (AHIP) to identify solutions for providing real-time updates and validation of provider directories through a single workflow. See the results!

Join us Friday, 3/10 at 1pm ET for our Ransomware Predictions and Prevention tweetchat featuring Matt Fisher (@Matt_R_Fisher) and Erik Azar (@eazar), where we’ll talk about how ransomware affects healthcare now, how to prevent a #ransomware attack, and what the future of #cybersecurity might hold for #healthcare.

Because patients are paying more out of pocket for their healthcare, you might be focusing on improving patient collection processes. While that’s critical, it’s also important not to lose sight of the other side of the revenue equation—the payer. Elizabeth Woodcock, MBA, FACMPE, CPC, an expert on medical practice operations and revenue cycle management, shares her thoughts on how to approach denials in your organization.

With all the uncertainty, there’s one question that keeps surfacing—will risk adjustment go away if Congress repeals the Affordable Care Act (ACA)? The answer is no and here’s why – risk-based financial models extend far beyond those included in the ACA.