Healthcare Industry
The Affordable Care Act (ACA), aka Obamacare, is unlikely to bring together Republicans and Democrats. But ACA is bringing innovation to healthcare payments arena. Standards within the law make it easier to reconcile electronic funds transfer (EFT) payments, most commonly Automated Clearing House (ACH) transactions, received by providers with the corresponding electronic remittance advice (ERAs), including EDI 835 or EOBs.
Read MoreAccording to a new survey by Black Book, the consulting business is booming in healthcare revenue cycle management; and rightly so! Challenges that executives cited for updating RCM projects include: 77 percent have not begun a strategic plan for transforming RCM solutions for known deadlines because of lack of internal experts to do so and 80 percent of CIOs said they do not have the IT staff in-house to transform RCM end-to-end.
Read MoreA recent Gartner report highlighted “5 Cloud Trends in 2013 and Beyond”. Have you ever heard of how cloud computing aims to create “Webscale” systems, which are large configurations that have this ability to expand and contract as needed? They can be configured quickly, and yet go away quickly too. No longer are “large scale projects” a problem in a cloud hosted environment. A good example in healthcare payments would be a project to convert a large back-log of explanation of benefits forms. In this project, a large virtual cloud could be created with high capacity for a few days…then it goes away.
Read MoreDon’t be afraid of HIPAA & HITECH? Of course it’s easy to say that if you aren’t the person knee deep in interpreting the rules and regulations and building out the infrastructure of a solution. The recent Orbograph White Paper, “HIPAA/HITECH Compliance, Resiliency and Security” simplifies the concepts of following and complying with these rules. When you look at HIPAA and HITECH initially, it’s critical to start with a high level perspective. With that in mind, HIPAA is pretty much two primary rules!
Read MoreYou’re a healthcare payments professional and by now, you probably have an opinion on the topic of reassociation. You’ve seen the Orbograph white paper, How to Reassociate EFT/ACH Payments to ERAs in 2014, and see why the industry needs to make a move in this area. If you haven’t read it, now’s your chance! Or check out http://www.caqh.org/. There’s only 161 days left to prepare for implementation deadline for federally-mandated CAQH CORE EFT and ERA Operating Rules…
Read MoreA recent survey on ICD-10 indicates that one-third of the 500 physician practices interviewed have not started compliance work yet. October 2014 is the implementation deadline, but how much time is really needed? Key highlights of the survey include: thirty-six percent of respondents who have not started ICD-10 preparations believe there is plenty of time to prepare, 26 percent don’t have the time, staff or training resources to start; and 22 percent don’t know where to start planning…
Read MoreInterested in hearing how proactive revenue cycle management approaches can minimize possible negative effects of healthcare legislation, namely ACA, ICD-10 and EFT/ERA standards? Check out this exciting newsletter from Orbograph. Orbograph will be discussing these topics at the HFMA-ANI show in Orlando, Florida. Stop by booth 639 or contact joe.gregory@Orbograph if you are interested in hearing more.
Read MoreThe HFMA conference brochure pretty much tells it all, “What Now?” The healthcare industry continues to evolve and converge around several critical pieces of legislation including ACA, EFT/ERA electronification and ICD-10. HFMA sessions look very interesting as they address many revenue related topics!
Read MoreIt’s a tough world out there for healthcare providers who are typically scrounging for 15-20% of their claims revenues which are either denied or incorrectly processed. ICD-10 is slowly approaching (10-1-2014), and with the number of codes jumping to 68,000 from the mere 14,000 of ICD-9, it made me wonder how much more difficult the billing and reconciling process may become for providers and patients as there are significant risks in this new process. Anne Smith, RN, principal and CEO of Fredrikson Healthcare Consulting, said, “while the biggest changes focus on code structure and conventions, it would be a mistake to assume only coders need training for the new system.“
Read MoreLet’s say that a financial institution (FI) wants to provide a medical lockbox processing solution to its existing healthcare provider customers and/or prospective customers outside its geographic branch locations. Ideally the system would process both insurance payments as well as patient payments. In order to get into this business, particularly capturing and scanning EOBs, the FI will need to follow the rules and regulations around HIPAA/HITECH; a potentially daunting and intimidating process!
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