Availity Blog

Availity Blog

Actionable insights for medical business professionals

Consumers with health insurance, both independent and employer sponsored, rely on insurers’ provider directories to make choices about their plans and find physicians that are right for them. Directories include vital information such as essential contact details, distance from public transportation, accessibility for individuals with disabilities, languages spoken by practitioners and staff members, and more.

The healthcare industry still has a big paper problem. According to one report, faxes account for almost 75 percent of all medical communication.

Health plans are committed to reducing waste and inefficiency, but the healthcare industry as a whole still spends too much time and money manually managing administrative transactions. One report found that faxes account for almost 75 percent of all medical communication, and the 2017 CAQH report predicted administrative costs would reach $315 billion by the end of the year. These costs are driven largely by the continued reliance on phone calls, fax, and mail to manage claims transactions.

Countless businesses and healthcare organizations miss out on their portion of available settlement proceeds each year. On average, only about 20% of eligible entities collect their share of any given settlement fund. In many cases, the proceeds represent a significant amount that is added right to your bottom line. While settlements vary, one constant is that a claim must be submitted in order to collect any money. This is where a Settlement Recovery Service can help.

The RISE conference in Nashville was a great opportunity to learn about new approaches to analytics and member engagement, as well as to hear about many of the creative initiatives health plans are implementing to improve quality scores and meet the complex web of risk adjustment requirements for Medicare Advantage, ACA, and Medicaid.

What’s the current state of payer-provider collaboration, and what does the future hold? Big questions to be sure, but we tried to find answers during a recent Availity-sponsored SmartBrief webinar featuring healthcare industry expert Jay Eisenstock of JE Consulting.

Join us Friday, 9/8 at 1pm ET for our tweetchat, Big Data - Present, Future, and Best Practices, featuring Availity Director of Data Management and Analytics, Jeff Currier (@_jcurrier_), as we discuss how healthcare can and IS using Big Data to improve everything from costs to patient experience.

Join us Friday, 8/11 at 1pm ET for our tweetchat, Patient as the New Payer – Patient Payments, featuring TSYS’s Director of Relationship Management, Ben Buchanan (@benbuchanan28), and our own Principal of Payment Solutions, Sean Kilpatrick (@spkilpatrick), as we discuss the why and how of assessing, capturing, and collecting patient payments in our new healthcare world.

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?

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.