There has always been pressure to “do more with less” and continually reduce operational costs. Labor costs is always one of the largest administrative costs for health plans and managed care payers. I’ve found this to be true in my past positions running health plan operations centers and it continues
In 2013, the Department of Health and Human Services (HHS) strengthened the enforcement of HIPAA and HITECH with the final omnibus rule (omnibus is a Latin term meaning “for everything”). But many covered entities and their business associates do not realize the legal ramifications of this rule. Because some of
The December 2014 “State of the Payor” industry survey compiled responses from over 120 leaders from health plans across the United States. They found that over 88% of those surveyed are currently using or plan to use technology as the catalyst to transform their organization this year. More than 87%
With less than 8 months until the mandated October 1, 2015, ICD-10 implementation deadline, it is now a race to the finish line for many small to mid-sized health plans and providers. While there is a very small minority that think there will be another delay, CMS and Congress have
The SymKey® Reprocess/Pend scenario (available via a query or TXT file) reprocesses EZ-CAP® status 9 paid claims by duplicating the claim and all detail lines, adjusting the original net pay of each line, re-pricing each claim line, adding a Processing Status note to reference the original claim, and then pending
Tuality Health Alliance (Tuality) is a physician-hospital community organization that contracts with over a dozen health plans. Their physician membership includes approximately 80 primary-care physicians and 200 specialists. Tuality went live with SymKey® for Plexis Claims Manager™ in mid-July, 2014. Within the first month, they were processing an average of
Hold your claims! When CMS has an issue, we all have an issue. The Medicare Physician Fee Schedule that was published in the Federal Register this past November has been cancelled by CMS for correction of unspecified errors. MACs will hold claims until at least January 15, 2015 due to
Carl Natale wrote today in his article “ICD-10 Data: Why U.S. healthcare needs to move on from ICD-9 coding” that while many opponents of ICD-10 say that it won’t improve patient care, the fact is that it will – just not right away. Compiling enough data to make a significant
HCIM honored as one of 2014’s Top 20 Most Promising Healthcare Consulting Providers by CIOReview, for its expertise in delivering technology solutions and consulting services to healthcare payers and managed care organizations HealthCare Information Management, Inc. (HCIM) was selected out of over 400 companies as one of the nation’s 20
In the aftermath of the 2014 midterm elections where Republicans gained control of the Senate and maintained control of the House, America is wondering what all this means for the Affordable Care Act. Junior Republican Senator Ted Cruz of Texas had already vowed to dismantle Obamacare once Republicans secured both
HCIM to Serve as the Exclusive Value-Added Reseller for PCG Software’s Virtual Examiner® and Virtual Reporter® HCIM and PCG Software, Inc. (PCG) today announced an exclusive value-added reseller (VAR) agreement to resell PCG’s Virtual Examiner® and Virtual Reporter® (VE/VR) claims recommendation software to the healthcare payer/managed care industry. With the
HCIM is pleased to announce that they have signed a Value-Added Reseller agreement with L5 Healthcare Solutions. HCIM will be reselling L5’s Claims Audit Tool™ to the Health Plan/Managed Care Payer industry. The Claims Audit Tool™ is designed to be used by the audit departments of organizations paying healthcare claims