Payers Under Fire – Meeting FHIR Deadlines
/ Posted in GeBBS Healthcare Solutions, Inc.As if 2020 wasn’t overwhelming enough for payers who are battling a global pandemic while navigating all the many changes it brings to policies and reimbursement – there’s also a mad dash underway to meet the deadline for Fast Healthcare Interoperability Resources (FHIR) exchange format standards which go into effect on July 1, 2021. This …
Is Technology the Remedy for HEDIS Headaches?
/ Posted in GeBBS Healthcare Solutions, Inc.Payers and healthcare providers alike are in the constant pursuit of the triple aim in healthcare – including better quality, greater value, and improved patient satisfaction – as the shift to value-based care continues. For every health plan on the market, it’s critical to review and evaluate quality performance on a regular basis to ensure …
The Six Most Important Changes Coming to Medicare Advantage Plans in 2021
/ Posted in GeBBS Healthcare Solutions, Inc.Enrollment in Medicare Advantage (MA) Plans continues to climb each year. In fact, Medicare Advantage enrollment has doubled over the last decade. As the program takes on its increasing share of Medicare beneficiaries, staying abreast of changes and developments to the program remains more important than ever. Next year’s changes to Medicare Advantage are both …
Price Transparency Pushes Forward in 2021
/ Posted in GeBBS Healthcare Solutions, Inc.While consumers continue to demand greater value in healthcare, they have very little way of knowing if they’re getting it. That’s because healthcare (payers and providers) – full of its complexities, technical coding, billing practices, and claims adjudication – is one of the least transparent industries out there when it comes to pricing. Whether patients …
Sweeping Changes for E/M Coding Are on the Way – What Do They Really Mean?
/ Posted in GeBBS Healthcare Solutions, Inc.Come 2021, outpatient evaluation and management, or more commonly known as E/M coding is getting a massive overhaul and will considerably impact how care is documented and reported. This past August, the Centers for Medicare & Medicaid Services (CMS) confirmed that several previously announced changes to E/M guidelines and pay rates for outpatient and office …
Verify, Verify, Verify – Why Insurance Verification is Money in the Bank
/ Posted in GeBBS Healthcare Solutions, Inc.Successful, accurate medical billing and reimbursement begins with ensuring every patients’ insurance information is accurately captured and thoroughly verified – ideally before the start of any encounter. That’s because failing to do so can result in payment delays or more likely claims denials – which can have a significant and negative impact on reimbursement and …
Struggles of Streamlining Scheduling in Healthcare – How to Make it Happen
/ Posted in GeBBS Healthcare Solutions, Inc.These days, if you want to schedule a haircut, vehicle repair, DMV appointment, or cable service – chances are, you can do it online with the click of a button. On the other hand, scheduling a hospital procedure or a routine doctor’s appointment might require multiple phone calls, voicemail exchanges, and frustrating phone trees before …
Precarious Problems with Prior Authorizations
/ Posted in GeBBS Healthcare Solutions, Inc.Patients and providers alike suffer the pain and financial implications of prior authorizations, also referred to as prior approval, pre-authorizations, or pre-certifications. A red tape-laden approval process required by government and commercial payers, prior authorizations are often required for numerous treatment options such as hospital admissions, procedures, surgeries, diagnostic testing, imaging services, therapies, and even …
When it Comes to Satisfaction, the Experience is Everything
/ Posted in GeBBS Healthcare Solutions, Inc.It’s true that in nearly every industry, the experience is everything. Failing to meet customer expectations is most certainly the demise, as the Amazon effect and consumerism have pushed people to expect more for less without delays or frustration. Yet, in healthcare – still many patients face delays and frustration at every step of their …
When it Comes to Payment, Accuracy is Everything
/ Posted in GeBBS Healthcare Solutions, Inc.In the consumer world, you pay for what you get. Unfortunately, in healthcare, it doesn’t exactly work that way. The complex world of healthcare billing means that patients and providers alike are often left confused with what items they’re being charged or for what services they’ve been paid. While there are several reasons for this, …