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Claims processing in healthcare refers to the insurance company's procedure to check the claim requests for adequate information, validation, justification and authenticity. This is an important process because it determines how much the insurance company reimburses to the healthcare provider. The businesses in this audience are interested in claims processing, learning more about the process, investing in new tools, etc.
Bundled payments require a set of healthcare providers to assume risk, as they must cover costs that go above the quoted price. Medical professionals in this audience may be seeking more information about joining a group that accepts these, also known as episode payment models (EPMs). Medical offices within this agreement share in the savings/losses in this agreement.
Claim denial happens when a health insurance company refuses to pay for something. The insurer can refuse to pay for a treatment, test, or procedure after a procedure has been performed or while seeing authorization. The businesses in this audience are interested in claim denials, and learning more about them and how they can affect their business, tools to better deal with claim denials, etc.
Claims auditing in healthcare determines the accuracy of claims. Retrospective auditing is a review or look back of closed or processed claims to determine whether cases are being handled and paid appropriately, and prospective auditing occurs before any payments are made. Businesses in this audience are seeking retrospective and prospective auditing solutions.
Exclusive Provider Organizations are insurance groups with a pre-determined set of in-network or out-of-network doctors, the latter of which is not usually covered by the plan or policy. These companies may offer affordable rates and a higher approval rating, but offer a more limited scope of healthcare options.
On average employers pay 82 percent of insurance premiums within a company. The most commonly offered types of benefits for part-time workers are health, dental and vision insurance. Companies may be seeking information about better plan offerings, lower premium costs and other ways to benefit employees and keep costs low.
Businesses may offer a health reimbursement account program in lieu of an employee insurance plan. This allows a business to use a tax-advantaged plan to reimburse employees for covered medical costs. Businesses may be looking for government backed or private HRA plans, cafeteria plans, QSHERA enrollment and more.
Bench-marking allows hospitals to compare how their organization performs against regional and national competitors, and can be an incentive for government funding. Medical executives in this list are interested in or in need of software and solutions for hospital executives to determine areas of their financial processes need improvement.
The healthcare revenue cycle includes all the administrative and clinical functions that go into the capture, management, and collection of patient service revenue. Medical professionals in this list are searching for software for managing and organizing the life-cycle of a patient account from creation to payment.
Some employers may choose a high-deductible health plan for their employees - a health insurance plan with lower monthly costs and higher deductible payments. Being covered by this type of plan is also a requirement when the employer offers an HSA or health savings account. Businesses in this audience may be seeking HSA options, HDHP plans and other non-traditional health plans for their employees.
Hospitals have so many moving parts and hard working staff members, no wonder setting and maintaining a budget is a daunting task. Hospital administrators in this audience may be seeking financial planning assistance, financial auditor, budgeting software like Questica Budget or Kepion, managing medicare and medicaid funding and more.
Once a patient leaves the office, every note and detail of the appointment is translated into alphanumeric codes which are then used to determine the final cost and billing. Medical billing departments take the coded patient information and make a bill and claim for the insurance company. Medical offices may employ this position in house, or outsource it to a variety of medical billing companies.
There are thousands upon thousands of codes for medical procedures. Once a patient leaves the office, every note and detail of the appointment is translated into alphanumeric codes which are then used to determine the final cost and billing. Medical facilities often hire workers for this position, or seek automated software and systems to complete these daily tasks.
Medicare is the federal health insurance program for those 65 or older and people with disabilities. There are several private companies that advertise to offer supplemental insurance plans to pair with medicare coverage, tandem hospital insurance, part D prescription coverage, Medicare Advantage plans, Medigap plans and more.
Pay for Performance in healthcare (P4P) is also known as value-based payment. These payment models provide financial incentives/disincentives based on patient feedback of provider performance. Healthcare professionals in this audience are researching concepts like value-based payments, patient satisfaction metrics and how they compare to traditional fee for service models.
Physicians, surgeons and other doctoral staff are paid well for their time, care and expertise. Often this is to help offset the many years of schooling and education costs. Medical offices and other facilities are likely to research competitive pay scales and industry news like the annual Medscape Physician Compensation Report.
Preferred Provider Organizations (PPO) are insurance groups with a pre-determined set of in-network or out-of-network doctors, the latter of which may not be fully covered by the plan or policy. These companies may offer discounted rates but offer a more limited scope of healthcare options.
Consumers in this list are interested in Premium-only-plans with which employees can save a set amount or a percentage on their insurance premiums that they deduct from their pay. They may be searching for the pros and cons of these plans, and solutions for implementing them.
The Healthcare Financial Management Association defines revenue cycle in healthcare as all administrative and clinical functions that contribute to the capture, management, and collection of patient service revenue. Medical institutions may seek a team of advisors to assist with the analysis of these metrics or may seek software options to automate the process.
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Despite growing ad budgets and clear results, new trends in advertising have driven an entire crowd of consumers to reject all kinds of promotions. A recent New York Times article chronicled this phenomenon perfectly. The article’s author, Tiffany Hsu writes, “As advertisers bombard consumers across platforms like Twitch, Facebook, television, billboards, and more, consumers are […]