Solutions

It’s imperative for payers and providers to launch re-enrollment initiatives to ensure continuous care and protect revenues when hundreds of thousands of patients are being disenrolled for procedural reasons.

Outsourced services, including medical billing, is expected to reach $29.3 billion by 2030. As digitization within #healthcare streamlines workflows, practices need to adopt advanced RCM tactics or risk falling behind. We’ve gathered the latest insights, along with tips to determine if a third party partnership is right for your organization.

The Provider Enrollment, Chain, and Ownership System – commonly known as PECOS – is the go-to online enrollment management system. It allows registered users to enroll as a Medicare provider or supplier, revalidate enrollment, electronically sign and submit forms, and more. Is your practice set up to follow the proper enrollment guidelines? Our new article uncovers how the use of a delegated authority that helps securely manage your enrollments within PECOS can ensure your credentialing is safe.

Industry experts believe that the number of payvider organizations will grow as more healthcare organizations look to diversify payment models and expand patient-centric capabilities. The value-based care model carries increased risks and benefits, and insurers and providers joining forces to increase the quality of care and minimize their financial risk can be a beneficial outcome for all parties involved. As the industry continues to evolve and organizations adapt, how will this organizational trend move the needle toward a more efficiently effectively managed revenue cycle?

How did one University of Texas teaching hospital identify more than $1 million in underpayments? Learn how a new revenue integrity strategy helped recover optimal reimbursements.

The time-consuming credentialing process gets even more complicated when closed panels come into play. How can physicians gain access when denied enrollment and ensure revenue?
We explore the options practices can take when closed panels cause a credentialing delay. Read our latest article for best practices to navigate the issue.

We live in a digital world. From smart phones to the internet to digital devices, technology is all around us. In fact, many of us use advances like augmented reality, voice assistance, blockchain or machine learning on a daily basis. While many industries utilize these technologies to enhance their products and services, unfortunately, it seems as though healthcare is playing catch up.

When the No Surprises Act went into effect on January 1, 2022, it raised more questions than answers for many physicians and administrators. More often than not, healthcare leaders were left wondering how, and when, they could be affected. It’s clear that a learning curve exists when it comes to the No Surprises Act.

WEDI survey results reveal No Surprises Act convening provider requirement poses significant challenges.

Accuracy is critical when it comes to credentialing. And with more than 85 percent of applications currently done online, physicians are heavily dependent on technology and automation. While digital applications may be a more efficient method than putting pen to paper, this streamlining also brings high risk.

At TriZetto Provider Solutions, we understand that data security is an important issue for our SaaS platform clients. Protecting our clients’ data in transmission and at rest remains one of our top priorities. We know how critical it is to keep protected healthcare information (PHI) secure and we continue to invest the effort and expense necessary to meet industry compliancy standards for data security.

Employee turnover was named one of the largest pandemic-related issues of the year. How can practices large and small mitigate resource shortages while continuing to operate on all cylinders? Analytics may hold the key to optimizing operations and revenue while navigating staffing woes.

Healthcare providers are being squeezed. Revenue streams are shifting with lower cost venues and reimbursement rate changes. Inflation and changing supply costs are driving expense-side challenges. How can practices not only navigate, but solve, the cash flow crunch? C2FO, a TriZetto Provider Solutions platinum partner, shares their best practices and cash flow solutions that will help your practice thrive.

Sutter Health, a not-for-profit headquartered in Sacramento, operates over 200 hospitals and clinics in Northern California.

Healthcare CEOs ranked personnel shortages as their most pressing challenge. In an unpredictable year, leadership is developing strategies to navigate staffing issues while aiming to secure optimal revenue at the same time – often with limited budgets.

One in four Americans hold vision coverage with VSP. With so many patients using the program, it’s critical to have credentials in place. How can vision providers ensure they are properly enrolled with the nation’s largest payer?

The No Surprises Act will affect patients and providers alike when it goes into effect. While the outcome is still unknown, the hope is that patients will be relieved of surprise medical bills without a change to providers’ revenue.

According to PatientPop, digital convenience is a priority for patients. Is it part of your 2022 growth strategy? Andrea Aldana, Content Manager at PatientPop outlines the steps to follow to have a successful growth strategy.

Underpayments are on the rise. Here’s how healthcare leaders can get what’s owed them by making changes to their revenue integrity programs.

If your organization is not utilizing data to its full capabilities, you could miss out on valuable insight and actionable revenue drivers. Incorporate analytics into your revenue cycle management to help improve collections and cash flow.

Enrollment status can greatly affect the dollar amount payers reimburse, and some specialists are opting to go out of network. We weigh the pros and cons of this trend to explain why it may make sense for select providers.

With two more states recently joining the list of locations that allow Full Practice Authority, many nurse practitioners are exploring the option of operating independently. As the need for qualified healthcare professionals continues to grow and the ability for NPs to practice independently continues to increase, quickly gaining credentials and navigating compliance challenges becomes more and more important.

72 million Americans have some sort of trouble paying medical debt. Much of this can be attributed to unexpected bills that pop up after unforeseen emergency visits and treatment from out-of-network providers. Thanks to new regulation, surprise medical bills may soon be a thing of the past.

In today’s ASC Environment, providers are constantly looking for ways to improve workflows, provide impeccable patient care and become financially healthy. Our partner, ShareableForms shares their best practices on how to improve efficiencies that your patients, staff and bottom line will be grateful for.

With healthcare costs on the rise and an increasing segment of uninsured consumers, the patient payment landscape is changing rapidly. How can medical offices evolve and optimize collections while keeping patient satisfaction high? Thankfully advancing technologies are making it easy to simplify collection processes to increase revenue.

When it comes to optimizing operations, automation is key. According to the CAQH Index report, the healthcare industry can save more than $16 billion by transitioning to fully electronic transactions. Discover the opportunities for healthcare providers to enhance operational processes and grow their business.

With vaccinations on the rise and many Americans returning to work and school, what’s ahead for healthcare? We spoke with Bobette Flagel, Director, RCM Services at TriZetto Provider Solutions, for a deep dive into the pandemic’s impact on claim volume, billing & operations. Hear lessons learned over the course of the last year, plus easy-to-implement best practices that can help practitioners move forward.

Analyzing closed cases can increase their profitability by 55 percent

To comply with Medicare revalidation requirements, providers need to be aware of the requirements and timelines. If deadlines are missed or submissions are incomplete, providers can be terminated from the program and required to reapply. Until a new application is processed and approved, which can cause delays and disrupt the revenue cycle.

Nearly half of U.S. states allow nurse practitioners to operate on their own, and credentialing is a critical component for those looking to establish their own practices. What do nurse practitioners need to know before becoming a standalone provider, and what is the simplest way to gain credentials?

TPS associates embody what it means to have a Heart for Service and are motivated by seeing our clients’ businesses thrive. Meet Grant, our 2020 Associate of the Year.

How can ambulances and EMTs ensure accurate credentials? Learn how TriZetto Provider Solutions can help deliver peace of mind for emergency medical technicians.

A new CMS rule is changing the patient experience. What can healthcare organizations do to navigate this change and work toward improving the overall patient experience? Read on to hear best practices and learn what’s coming next for patients.

Uncovering a new provider’s credentialing statuses can be time-consuming and confusing. Here is how billing services can simplify your clients’ credentialing with the right partner.

Which RCM strategies will prove to be the most effective in 2021? Read our Q&A session with revenue management leaders to gain actionable insight that your practice can implement today.

Medicare Advantage has gained popularity in recent years, and there seems to be no end in sight. While the benefits to consumers are obvious, what complications does this growth bring providers?

The need for mental health services has been placed at the forefront because of pandemic-related stressors, but specialists often find that gaining credentials can be a complicated process. Discover tips and solutions that can make it easier.

Telehealth is just one piece of a “care anywhere” strategy. Both payers and providers have a role in delivering experiences that resonate with consumers.

Telemedicine, staffing issues and other changes caused by the COVID-19 pandemic are uprooting the way medical practices are managed. Obviously healthcare has been thrown through a loop this past year, and healthcare professionals are eager for a return to normalcy. How can practices navigate the unknown and succeed in 2021?

Health plans require all in-network physicians to submit current credentials to the Council for Affordable Quality Healthcare (CAQH) database. Learn more about the highly manual, time-consuming application, and the required quarterly updates for re-attestation can be onerous.

Help protect your organization from cybercrime by adopting these industry-recognized best practices.

In recent years, telemedicine was on the path to become more than just a buzzword. According to a survey conducted by the American Medical Association, telemedicine visits had doubled since 2016.

Gain a high-level overview of CMS evaluation and management coding changes going into effect on January 1, 2021.

Did you know that three percent of net revenue loss is caused by denials? With the profound changes in healthcare this year, how can providers stay ahead of their revenue cycle while managing the day-to-day needs of patients?

Help protect your financial wellbeing and optimize your revenue cycle with these coding tips.

This year’s coronavirus serves as the catalyst for a more complex model of care delivery.

The demand for nurse practitioners is expected to grow by 36 percent by 2026. Learn more about the revenue opportunity this growth presents for practices and nurse practitioners.

With an increasing amount of coverage changes happening at the moment, it’s now more important than ever to verify medical benefits and determine accurate patient coverage.

Healthcare continues to be one of the most disrupted markets, and we see that trend set to continue for the next decade.

Across the US businesses have taken part in The Paycheck Protection Program.

Many patients have put off non-critical medical appointments in recent months as the unknowns of the COVID-19 pandemic kept us at home. For optometrists, this means routine eye exams and contact lens prescriptions were put on hold.

Telemedicine visits, remote staff, new codes and changing patient coverage – medical practices have a lot to juggle today.

The healthcare industry is facing a challenging time, with providers and administrators determined to deliver high-quality care while managing financial pressures.