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McKesson Health Solutions Extends VBR Portfolio with ClarityQx Value-Based Payment Technology

Acquisition expands McKesson’s ability to support health plans in scaling bundled payment programs

NEWTON, Mass. and KING OF PRUSSIA, Pa.—July 12, 2016Last month McKesson Health Solutions released a national study that found value-based reimbursement (VBR) has firmly taken hold but that payers and providers are struggling to operationalize some of the fastest growing payment models.

Today McKesson Health Solutions announced it has expanded its portfolio to include ClarityQxvalue-based payment technology through the acquisition of HealthQX™.  This technology enhances McKesson’s ability to help customers rapidly and cost-effectively transition to value-based care by automating and scaling complex payment models, such as retrospective and prospective bundled payment.

Health plans use ClarityQx for analytics and for automation of retrospective bundled payment models and McKesson’s Episode Management™ to support automation of prospective bundled payment. Pairing ClarityQx with McKesson’s Episode Management gives health plans the ability to automate retrospective bundled payment processes today and move to prospective payment as they are ready.

“The growth of bundled payment is something payers and providers can’t ignore, and we want to ensure our customers have all the tools they need to succeed,” said Carolyn Wukitch, senior vice president of McKesson Health Solutions. “These new value-based payment analytics, reconciliation, and automation capabilities complement our value-based reimbursement suite, because they give our customers the capabilities to prepare for and scale bundled payment.”

Payers and providers are under immense pressure to operationalize bundled payments. Bundled payment is projected to be 17% of medical reimbursement by 2021, making it the fastest growing payment model. And the CMS is now mandating bundled payment in one out of every five metropolitan areas as part of its goal to make alternative payment 50% of reimbursement by 2018. Yet just half of payers and only 40% of providers are ready to implement bundles, and nearly 75% don’t have the tools they need to automate these complex models.

Now, with the addition of ClarityQx, McKesson can offer health plans a more complete portfolio that can automate their medical policy, payment policy, value-based reimbursement models, provider management, and contract management.

In addition to ClarityQx, McKesson’s Network and Financial Management portfolio also includes McKesson Episode Management™ prospective bundled payment automation solution,McKesson ClaimsXten™ advanced claims auditing rules engine, McKesson Reimbursement Manager™, McKesson Contract Manager™, McKesson Provider Manager™, and McKesson Payer Connectivity Services™.

ClarityQx was developed by HealthQX, a leading vendor of value-based payment analytic solutions for health plans and providers, which McKesson acquired in June.

“We’re thrilled to be joining McKesson Health Solutions,” said Mark McAdoo, CEO of HealthQX. “The integration of our two companies is reflective of our customers’ needs to rapidly transition from volume to value-based payments.”

About McKesson

McKesson Corporation, currently ranked 5th on the FORTUNE 500, is a healthcare services and information technology company dedicated to making the business of healthcare run better. McKesson partners with payers, hospitals, physician offices, pharmacies, pharmaceutical companies, and others across the spectrum of care to build healthier organizations that deliver better care to patients in every setting. McKesson helps its customers improve their financial, operational, and clinical performance with solutions that include pharmaceutical and medical-surgical supply management, healthcare information technology, and business and clinical services. For more information, visit

July 12, 2016 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

RelayHealth Financial Automates Creation, Management and Tracking of Denied Claim Appeals

RelayAssurance Appeals Assist helps improve revenue health by increasing collection rates on denied claims

ALPHARETTA, Ga., June 27, 2016RelayHealth Financial today introduced RelayAssurance™ Appeals Assist, a new tool that lets providers quickly and easily identify, create, file, and track appeals for denied claims. Now hospital and health system CFOs and revenue cycle leaders can enhance their denial prevention strategy with a way to expedite the appeals process– helping to reduce the associated time and costs, and improving the collection rate on initially denied claims.

While an estimated 6.4% of all provider-submitted claims are initially denied by payers1, two thirds of those claims are recoverable2. Yet many healthcare providers do not appeal denied claims at all, while others dedicate in-house staff or enlist outsourcing firms, which can result in lost revenue, wasted productivity due to manual processes, and significant expense. With RelayAssurance Appeals Assist, denied claims are flagged, the appropriate appeal forms are assembled and completed, and their progress is tracked–all within the same RelayAssurance Plus workflow used to monitor and manage claims.

“Despite providers’ best efforts to submit clean claims, a substantial number still get denied,” said Marcy Tatsch, vice president and general manager, Reimbursement Solutions, for RelayHealth Financial. “An effective denial prevention strategy doesn’t just focus on pre-submission, but also on the other points along the claims continuum. RelayAssurance Plus already offers the robust editing, claim status, and lifecycle visibility capabilities that are essential to denial prevention, and now builds on that functionality with the ability to track a claim’s progress and quickly respond when help is required.”

RelayAssurance Appeals Assist complements the RelayAssurance Plus claims management suite by offering:

  • Integrated Denial Management–Users can quickly and efficiently identify that an appeal is needed, then create, print, and file that appeal and track its progress directly within the same RelayAssurance Plus workflow where claim status/tracking takes place.
  • Forms Library–Built-in standard Medicare appeal forms, templates and letters, along with state-by-state appeals submission requirements help reduce the time and effort required to file appeals.
  • Appeals Dashboard–Visual icons indicate the status of appeals (Created, Submitted, Denied, Succeeded), whether an appeal follow-up has been established based on payer-specific time thresholds, and alert users to filing deadlines–all to ensure active management of appeals.

RelayAssurance Appeals Assist is the latest module available to users of RelayAssurance Plus, RelayHealth Financial’s cloud-based, analytics-driven claims and remittance management solution. Other modules available to complement RelayAssurance Plus include: the new Status Amplifier™, which automatically tracks down, inspects, and reports accurate reasons for non-payment on claims; RelayAssurance™  Medicare Direct Entry, for integrated Medicare claim processing, and automatically-generated secondary claims; Host Integration Services, which helps reduce the need to manually post transmitted claim status information; and Eligibility Claim Edits to monitor for insurance changes.

For more information on RelayHealth Financial’s revenue cycle management solutions, visit our website, learn from our experts at the RelayHealth blog, or follow us on Twitter at @RelayHealth.

For more information on McKesson Health Solutions, please visit our website, hear from our experts at MHSdialogue, follow us on Twitter, like us on Facebook, or network with us on LinkedIn.

1 2015 RelayHealth data

2 “An ounce of prevention pays off: 90% of denials are preventable” Advisory Board, 2014

June 27, 2016 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Survey: Hospitals Progressing Slowly toward Medicare’s Goal of 50 Percent Value-Based Reimbursement by 2018

Respondents cite analytics as most important success factor for value-based reimbursement

SALT LAKE CITY – MAY 9, 2016 – Fewer than a quarter of U.S. hospitals are on track to hit the Obama Administration’s 2018 goal of providing at least half their patient care through so-called “value-based” arrangements – structures that tie reimbursement from Medicare to the quality of care patients receive.

That is one finding of a new online survey of healthcare executives representing 190 U.S. hospitals with a total of more than 20,000 licensed beds. The survey by Health Catalyst revealed that just 3 percent of health systems today meet the target set by the Centers for Medicare and Medicaid Services (CMS). Only 23 percent expect to meet it by 2019, a year after CMS had hoped that half of all Medicare reimbursements would be value-based.

According to the survey, the majority of health systems—a full 62 percent—have either zero or less than 10 percent of their care tied to the type of risk-based contracts identified by CMS as “value-based,” including Medicare accountable care organizations (ACOs) and bundled payments. Not surprisingly, small hospitals with fewer than 200 beds comprised the majority of those reporting no at-risk contracts. A contributing factor may be that smaller hospitals are five times less likely than larger organizations to have access to sufficient capital to make risk-based contracting work, according to the survey.

Despite lagging behind the federal government’s goal, healthcare executives across the board intend to steadily increase value-based care and at-risk contracts. In the next three years, all but 1 percent of respondents expect their organizations to be engaged in at-risk contracts. Sixty-eight percent said they expect risk-based contracts to account for less than half their total care in that time frame. Only 23 percent expect value-based care to account for more than half of their care in the next three years. Eight percent of respondents said they could not predict the answer.

Analytics tops the list of must-haves

The most important organizational element needed for success with risk-based contracting is analytics, said responding executives at both small and large hospitals. In fact, 52 percent of respondents cited the prime importance of analytics, more than double the second most-selected answer: a culture of quality improvement. Twenty-four percent of respondents cited cultural alignment on quality as having the most impact on value-based care success.

“Transitioning from fee-for-service reimbursement to value-based payments is a goal that many healthcare organizations embrace but are having difficulty implementing as they juggle a number of other high priorities,” said Bobbi Brown, Health Catalyst vice president of financial engagement. “This survey reveals that they’re making progress but they could use a little help – some of it financial and some of it technical in the way of better analytics to help identify at-risk populations and better manage their risk. The bottom line seems to be that while progress is slow, healthcare leaders are committed to making value-based care work.”

Survey results reflect the opinions of 78 healthcare professionals who responded to an online survey by Health Catalyst in May 2016. Over half of the respondents (51 percent) were CEOs or CFOs of large hospital-owned physician groups and hospitals ranging in size from 15 acute care beds to over 1,000 beds. The remaining respondents all held executive roles, including several Chief Medical Information Officers, Chief Medical Officers and Chief Nursing Officers.

The organizations represented include many well-known multi-hospital and multi-state health systems with a cumulative 756 inpatient and outpatient facilities and 20,416 acute care beds.

About Health Catalyst

Health Catalyst is a mission-driven data warehousing, analytics and outcomes-improvement company that helps healthcare organizations of all sizes perform the clinical, financial, and operational reporting and analysis needed for population health and accountable care. Our proven enterprise data warehouse (EDW) and analytics platform helps improve quality, add efficiency and lower costs in support of more than 70 million patients for organizations ranging from the largest US health system to forward-thinking physician practices. For more information, visit, and follow us on Twitter, LinkedIn andFacebook.  

June 9, 2016 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Statement by Joe Baker, President of the Medicare Rights Center, on the President’s 2016 Budget

New York, NY—In this 50th anniversary year for the Medicare program, the President’s budget request contains some good news for Medicare beneficiaries and their families. The good news—the budget outlines responsible solutions to slow Medicare spending, suggests a path to accelerate value-based delivery system reforms and names seemingly small, but critically important, legislative fixes to enhance the program. But there is some bad news as well—the President continues to endorse harmful proposals to shift higher health care costs to Medicare beneficiaries, both now and in the future.

We share the President’s deep concern about the rapidly rising cost of high-priced specialty and brand name medications, and we applaud proposals in the budget that would reduce wasteful spending on prescription drugs. We strongly support proposals to allow the federal government to negotiate prices for breakthrough medicines, to restore Medicare’s ability to benefit from the same prescription drug discounts that Medicaid receives, and to accelerate closure of the Part D prescription drug coverage gap (or doughnut hole). These policies represent sensible savings solutions that do no harm to people with Medicare.

We appreciate that the President’s budget expressly commits to hosting the 2015 White House Conference on Aging, and we hope that this venue will provide a forum to advance needed improvements to the Medicare program. Among these are options like that included in the President’s budget to simplify the appeals process for beneficiaries dually eligible for Medicare and Medicaid. This proposal would alleviate known barriers to accessing needed health care services for low-income beneficiaries unable to navigate the needless complexity of a fragmented appeals system.

Access to an adequate appeals mechanism and other beneficiary protections are a central concern with the President’s new request to implement a program in Medicare Part D to limit provider and pharmacy access for individuals suspected of prescription drug misuse. We urge both Congress and the President to preserve beneficiary access to medically necessary drugs and to adequately engage both the provider and beneficiary community in the design of any such program.

Finally, we remain deeply concerned by proposals that would shift the burden of higher health care costs to low-income and middle class beneficiaries, such as policies to further means test Medicare premiums, add a home health copayment, increase the Medicare Part B deductible, tax supplemental Medigap plans and hike brand name drug copayments for low-income beneficiaries.

February 3, 2015 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

H.I.M. ON CALL Launches Dual Coding Service to Help Hospitals Prepare for ICD-10

ICD-10 Testing Requirement Now Supported by Outsourced Coding Firm

Allentown, PA, March 26, 2013: H.I.M. ON CALL, a technology-driven outsourced services company for health information management (HIM), coding and revenue cycle, announces the availability of its dual coding services for hospitals migrating from ICD-9 to ICD-10. Dual Coding is a precursor to end-to-end testing of ICD-10. Payers want to test with providers that can submit ICD-10 codes. The new, dual coding service from H.I.M. ON CALL provides the people, processes and technology required for dual coding and supports ICD-10 testing with payers. The announcement was made by Manny Peña, RHIA, President, H.I.M. ON CALL.

Expert, outsourced coders from H.I.M. ON CALL perform ICD-10 coding via remote or onsite options; allowing the hospitals’ internal coding team to focus on day-to-day production or ICD-10 training, education and ramp-up.  The firm generates dual coding data output and analytics to identify gaps in clinical documentation for ICD-10. Back-up ICD-9 coding services are also available.

“Dual Coding’s data and analytics support our customers’ clinical documentation improvement (CDI) ramp-up for ICD-10,” explains Peña. Specific documentation weaknesses and target areas for revenue loss under ICD-10 are identified.  Some of the features of the new dual coding service include:

  • Perform dual coding (ICD-9 and ICD-10) for up to one year prior to October 1, 2014.
  • Support end-to-end testing initiatives by providing ICD-10 coded cases.
  • Provide monthly summary, data and analytics of CDI issues (ICD-9 and ICD-10).

“In addition to opening the door for end-to-end payer testing, our data and analytics are a tremendous support to ICD-10 teams,” adds Karen Karaban, RHIT, CCS, Director of Coding Integrity at H.I.M. ON CALL.  Accurate, complete and specific clinical documentation is the foundation for correct reimbursement, quality reporting and continuing care. The H.I.M. ON CALL service provides a summary of documentation findings by ICD-10-CM/PCS chapter, patient type, medical service and physician. The potential financial impact due to the lack of specificity in the documentation is also identified with actual and projected decreases in coding productivity by patient type and medical service.

More information about the firm’s dual coding service can be viewed at the firm’s blog or by contacting Joseph J. Gurrieri, RHIA, CHP, Vice President & COO at: 610.435.5724 Ext. 131.

About H.I.M. ON CALL:

H.I.M.ON CALL is a technology and outsourced services company for health information management (HIM), coding, clinical documentation improvement (CDI) and revenue cycle. They offer data-rich technology tools and outsourcing services to make better coding decisions and prepare for change. Service offerings include coding, coding audits, CDI consulting and ICD-10 education. Their AVIANCE Health™ suite of web-based software applications includes audit management, DNFB management, coding analytics and electronic document management. Founded in 1998 and based in Allentown, Pennsylvania, the company is focused on the future and willing to embrace new ideas; delivering financial value in everything they do.

March 26, 2013 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

PriMed Selects NextGate EMPI to Support Coordination, Quality, and Safety by Ensuring Consistent and Complete Patient Records for Flagship Client

Management Services Organization Brings Together Data of 300,000 Patients from 3,700 Providers Across Multiple Specialties and Locations for Hill Physicians Medical Group

MONROVIA, Calif. — January 8, 2013 — NextGate, a leading provider of Enterprise Master Patient Index (EMPI) and registry solutions, today announced that PriMed Management Consulting Services, Inc., the management services organization (MSO) for Hill Physicians Medical Group (HPMG), will implement NextGate’s enterprise master patient index (EMPI) software as the foundation for a broad-based Care Management platform to support Hill Physicians’ 3,700 providers. This solution is designed to link patient records across all phases of the care process, as well as ensure the accuracy and completeness of patient data for one of the nation’s largest physicians groups.

PriMed will use NextGate’s sophisticated registry platform to identify, index, and link patient records from Centricity (IDX), NextGen EHR, Dignity Health, UCSF, and multiple health plans and laboratories into a consolidated, consistent and centralized EMPI.

“An efficient MSO must provide reliable and accurate patient information in order to improve physician adoption, increase clinical collaboration, and avoid unnecessary administrative expenses.  Access to organized and consistent patient information, regardless of practice location or vendor system, empowers our member physicians and participating organizations,” said PriMed’s Chief Information Officer, Craig Lanway. “NextGate supported an earlier project of ours, and their knowledge, expertise, and technology for patient identity management is best in class.”

“As the MSO for one of the largest physician groups in the country, PriMed faces the same challenges we see in ACOs, HIEs and integrated delivery system operations.” stated Andy Aroditis, President and CEO, NextGate. “As the healthcare landscape becomes increasingly digital and interconnected, maintaining an accurate view of the same patient across disparate systems is critical. The complexities of the relationships we need to understand and map require a more sophisticated approach to identity management than ever before. We see this shift reflected in increasing demand for our platform, and we are pleased to help organizations like PriMed maintain the infrastructure required for today’s healthcare integration needs.”

NextGate EMPI uses intelligent matching algorithms to recognize related entities spread across different applications and locations, and links them together under an Enterprise ID in a comprehensive master index, enabling a secure and accurate exchange of patient information.

About PriMed
PriMed Management Consulting Services is the management services organization (MSO) that organized Hill Physicians Medical Group in 1984, and employs approximately 500 people. PriMed provides technology, claims processing, customer service, EHR, patient and case management and authorization reviews to support physician practices. PriMed strives to maintain a strong but cost-effective infrastructure that can help physician offices achieve economies of scale, as well as create and support a high-quality, competitive medical delivery system in Northern California.

About NextGate
NextGate provides Enterprise Master Patient Index (EMPI) and registry solutions that integrate, index and coordinate data from disparate systems to provide unified views of patient data, expedite decision processing, and streamline interoperability to drive performance. NextGate solutions clean and coordinate data to improve operational efficiency, discover new associations and insights, and reduce the potential for costly errors. NextGate’s innovative MatchMetrix® Technology Platform serves as the foundation for the company’s advanced, enterprise-class registries, and provides an integrated environment to develop customer and domain specific solutions that expand as requirements evolve. For more information visit:

January 31, 2013 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Asterino & Associates Moves Medical Billing Software to the ClearDATA Cloud to Ensure Data Protection and Streamline Operations

MS Office, SQL Server, and MS Exchange also Moved to ClearDATA Cloud

Phoenix, AZ, October 15, 2012 – – ClearDATA Networks, Inc., the leading healthcare cloud computing platform and service provider, today announced that Asterino & Associates, Inc (A&A),a leading provider of medical billing and practice management services  located in Scottsdale, AZ, has moved its on-premise data center including; medical billing software, MS Office Suite, SQL Server, and MS Exchange servers to the ClearDATA Healthcare Cloud Platform.  After careful analysis, A&A determined that moving its software applications to the cloud would provide greater data security, increase redundancy and streamline operations by allowing its staff to focus on delivering excellence within its medical billing and collections business and state of the art security and efficiency capability.

A&A provides medical billing and collection services to physicians and healthcare systems across the United States. By hosting its applications and servers with ClearDATA, A&A is able to provide a high performance, reliable, billing services to clients regardless of their location. Cloud hosting also enables them to cost effectively scale its business by adding virtual servers and storage as needed, instead of having to purchase and maintain additional capacity

“Moving our applications and infrastructure to the ClearDATA cloud allows us to focus more on our core competency rather than maintaining our datacenter,” said Christopher J. Asterino, Chairman & CEO of Asterino & Associates.  “It is important to achieve “Best Practice” in all aspects of our business.  This relationship achieves our objective with regards to data security, redundancy and business continuity. With leadership provided by our Advisory Board, we thoroughly researched our clients’ data needs and went with ClearDATA because of its exclusive healthcare focus and HIPAA expertise.”

About Asterino & Associates, Inc

Since 1987 Asterino and Associates, Inc. has been providing medical billing and medical practice management services to both hospital-based and community-based physician groups across the United States. Asterino and Associates, Inc.’s dedicated team of over 75 healthcare professionals are devoted to assisting medical practices meet their business objectives with revenue cycle  management inclusive of medical coding, billing and collections and practice management consulting services. For more information, visit:

About ClearDATA Networks, Inc.

ClearDATA Networks, Inc. is the market leader for cloud computing and information security services for healthcare providers, software vendors and VARs, and 100% dedicated to the healthcare field. ClearDATA’s services enable providers to fully automate and securely manage healthcare medical records, applications, IT infrastructure and digital storage. The company provides HITECH HIPAA-compliant cloud and hosting infrastructure and managed cloud services, offsite backup and disaster recovery, medical image archiving, healthcare information security and world-class support. The company also offers HIPAA Security Risk and Remediation services to hospitals and providers in order to ensure that they meet the rigorous standards of HIPAA security required for protected health information to demonstrate Meaningful Use and to ensure a highly secure environment prior to enabling a HealthDATA Cloud platform installation. For more information, call 602-635-4000, email: sales@) or visit:

November 22, 2012 I Written By

Amphion Medical Solutions Helps Hospitals Leverage New ICD-10 Deadline to Address Coder Shortage

One-year bump in new coding system go-live provides hospitals a unique opportunity to leverage a full array of supplemental staffing options

MADISON, Wis. – Oct. 16, 2012 – Amphion Medical Solutions, an innovative provider of transcription and coding technology and outsourcing services, is poised to help hospitals and healthcare organizations meet the critical staffing challenges predicted to occur in tandem with the coming ICD-10 transition. Recently delayed to Oct. 1, 2014, the new deadline for converting to the expanded coding system provides hospitals with a unique opportunity to identify innovative approaches to proactively address anticipated staffing gaps created by the increased demand for services.

“The healthcare industry is facing a shortage of nearly 70,000 coders in the coming years, and hospitals that expect to meet the ICD-10 challenge should already be taking steps to address workforce demand,” said Mike Cavill, chairman and co-founder, Amphion Medical Solutions. “Amphion understands these challenges and has packaged a full array of options that cover strategies for both internal staff expansion and third-party outsourcing to meet needs.”

The magnitude of the ICD-10 transition—which expands the number of diagnosis and procedure codes from 17,000 choices to 141,000—is one factor contributing to increased coder demand that industry estimates predict will lead to shortages of 30% to 50% nationwide. Further escalating the problem is a growing aging population that will require more healthcare services and more extensive medical care, alongside an aging coder workforce that may choose to retire rather than invest time in learning the new coding system.

To counter these trends, Amphion offers a comprehensive package of coding solutions, starting with overflow services and extending to full outsourcing. Services can be designed to cover long-term contracts or work on a project-by-project basis to alleviate costly backlogs that can delay billing and reimbursement processes in hospitals. Amphion also provides ICD-10 training programs that include pre- and post-assessment tools to identify staff knowledge gaps and ensure readiness.

To further develop in-house coding resources, Amphion offers turn-key and customizable training programs to cross-train and transition complementary staff functions to coding. In particular, transcriptionists can be a great resource pool to draw from as a closely-aligned function that is currently facing the opposite problem—downsizing. Training programs can be provided onsite or remotely with one of the company’s coding educators leading the classes and are backed by 100% quality monitoring that ensures 95% accuracy.

About Amphion Medical Solutions

Founded in 2001, Amphion Medical Solutions ( delivers complete services and technology solutions to meet healthcare clients’ transcription and coding needs. With extensive healthcare expertise and leading-edge technology, Amphion leverages the proven benefits of transcription and coding outsourcing and provides organizations with the technology they need to manage an in-house transcription team. Featured products include Triton, a speech understanding transcription platform, and Themis, a remote coding solution.

I Written By

New Tool from RealMed Resolves Claim Denials Faster, Improves Physicians’ Cash Flow

Health Care Providers Can Resolve Denied Insurance Claims Faster, to Reduce the Cost of Collection

INDIANAPOLIS–(BUSINESS WIRE)–RealMed announces the addition of a denial management tool that helps physician practices resolve their denied insurance claims more quickly, resulting in better cash flow for the practice.

Reducing the cost to collect on unpaid medical claims is a significant financial challenge for physician practices, where the average practice may experience a claim denial rate of greater than 10 percent, with more than 60 percent of those denials ultimately being written off due to their difficulty to collect.

Physician practices now have the ability to analyze claim denials using detailed reports, so they can more quickly initiate process changes to close gaps in time-to-payment. Using RealMed’s enhanced real-time reporting and on-demand explanations of benefits, physician practices can determine if denials are payer-specific, biller-specific, coding errors, or part of a pattern — and can take action.

According to RemitDATA, the company whose processing enables the new RealMed tool, physician practices can expect to reduce denial rates to three to four percent, a level associated with best practices as described in the 2011 MGMA study of performance and practices of successful medical groups.

“Providing health care management solutions that enable real transparency into our customers’ claims, billing and collection processes translate into significant cost advantages that include lowering denial rates, being paid faster and improving staff productivity,” says Scott Herbst, senior vice president of provider solutions at RealMed. “By including RealMed’s denial management tool among our portfolio of offerings, we can continue to support our customers’ growing need to improve financial and operational process efficiencies.”

Physician practices can benchmark their business performance against peers, which is especially important as evolving payment models and new coding practices are changing the landscape for physician reimbursement. Armed with information about how their denial rates compare with similarly sized competitors in the same specialty, providers can adjust workflows and automate rework to become more efficient.

“Strategic insight to denial patterns can create a distinct financial advantage for physician practices,” said Sean Kilpatrick, director of the provider portfolio for RealMed. “Simply put, denial management tools can help health care businesses run better — and in this era of emerging new payment models and continuously changing regulatory mandates such as ICD-10 and ANSI 5010, physician practices need every advantage they can get.”

About RealMed

RealMed, an Availity company, is a national leader in revenue cycle management solutions for the health care industry. RealMed solutions connect physicians, practice management systems and health plans with essential real-time business information to drive staff productivity and facilitate better patient experiences. For more information, visit or call 877-RealMed.

November 18, 2012 I Written By

Verizon Offers Six Tips to Help Consumers Protect their Personal Health Information and Fight Health Care Fraud

BASKING RIDGE, N.J. – “The best protection against health care fraud in the U.S. is a cautious and vigilant consumer, and all of us should be aware of common tactics and abuses that are driving up our health care costs,” says Verizon Health IT Solutions Managing Director Renu Chipalkatti.

About 10 percent of the $2.6 trillion spent annually on health care goes to fraud and abuse, including falsified billings, false coding of services, billing for services not delivered or excessive, and billing separately for elements that should be part of a bundled service.

To help in the estimated $260 billion battle against annual health care fraud, Verizon offers six tips for consumers, including:

1.      Guard your personal information – Provide your insurance identification only to those who provide you with medical services and don’t allow anyone to borrow your insurance identification/Medicare card.

2.       Beware of “free” medical services – If it sounds too good to be true, it probably is. A common fraud scheme has door-to-door or telephone sales people offering medical services or equipment for free in exchange for your insurance/Medicare identification number.

3.      Keep accurate medical records – Even if your doctor uses electronic medical records, you should always keep your own records. You could use a personal health information service or keep a written record of any medical services and medications you’ve received – just write down the doctor or doctors you saw, the services you received, and when they occurred.

4.      Review your medical bills — Be sure to ask for your bill at the time of your doctor visit. Then check your bills and compare it with your insurer’s description of your benefits to make sure you aren’t charged for services you didn’t receive or charged for the same service twice. Also check that the dates of services and charges match up. If you find a problem or have questions, contact your health care provider immediately. If your questions are not resolved, contact your health plan provider.

5.      Destroy medical records before discarding – Be sure to shred or rip up any medical documents to stop your information from ending up in the wrong hands, or worse yet, having your identity stolen.

6.      Report possible fraud – If you suspect you’re a victim of fraud, contact your health plan provider or the Department of Health and Human Services, Office of the Inspector General. 

In an encouraging sign that efforts to combat health care fraud and abuse are gaining momentum, public and private health insurance companies are adopting new methods of detecting and preventing fraud.  There are still some providers who use the “pay and chase” model – which is ineffective and expensive – but a growing number are focused on aggressive, proactive approaches.

Predictive modeling technology, for example, can proactively identify unusual patterns in provider behavior that can indicate fraudulent activity. Verizon offers this as part of a comprehensive set of prevention, detection and management tools to help combat fraudulent health care activity.

Verizon’s Fraud Management for Healthcare service is able to monitor 100 percent of claims in near-real time and automates pre-payment detection with speed and efficiency.  Verizon builds models to detect specific behaviors that signal fraud, flags them and assigns a priority based on a risk score so case managers can focus on the activities that will have the biggest impact.

Verizon’s health IT practice offers a comprehensive portfolio of managed, IT and consulting services for the health care industry to help transform patient care delivery, enhance access to care and better manage costs.

Verizon Communications Inc.

(NYSE, Nasdaq: VZ), headquartered in New York, is a global leader in delivering broadband and other wireless and wireline communications services to consumer, business, government and wholesale customers.  Verizon Wireless operates America’s most reliable wireless network, with nearly 96 million retail customers nationwide.  Verizon also provides converged communications, information and entertainment services over America’s most advanced fiber-optic network, and delivers integrated business solutions to customers in more than 150 countries, including all of the Fortune 500.  A Dow 30 company with $111 billion in 2011 revenues, Verizon employs a diverse workforce of 184,500.  For more information, visit

November 17, 2012 I Written By