Availity Blog

Availity Blog

Actionable insights for medical business professionals

Understanding the needs of customers is paramount to any business’s success. And for Availity, a long-time, trusted intermediary between health plans and providers, understanding and appeasing both segments of the healthcare market has its challenges. Despite the development of integrated digital tools and improved processes and workflows, the relationship between these healthcare stakeholders is historically influenced by friction—even though both recognize a need to work together.

During this 2017 transition reporting year for MACRA, the requirements might feel overwhelming, but it’s important to put things into perspective. One of the most important thing you can do right now is to look at your quality measures and your clinical documentation activities and see where you can make improvements. The following are three things to keep in mind.

Elizabeth Woodcock, a leading expert on medical practice operations, is on a mission to help the healthcare industry improve the patient experience. In conjunction with the Availity Learning Center, she created a new on-demand training series, The Patient Relations Superstar, which launches this month.

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.