Care Coordination Market to Grow 26.1 Percent CAGR in Next Five Years

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The market for care coordination technology is predicted to grow 26.1 percent annually between now and 2020, according to a recent Frost and Sullivan study. The study defines care coordination software as “applications that are specifically designed to enable team-based patient care, particularly for at-risk patients with chronic conditions and for patients transitioning between care settings (e.g. hospital to home).” Frost and Sullivan emphasizes that this definition is not pristine, as there is a range of rudimentary to robust solutions that can fit into the care coordination bucket. Key Factors Affecting Market Drivers and Restraints Why care coordination market growth… Read More

Categories: Coordinated Care, Healthcare Trends, Data Insights

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New Insurance Authorization Integration for Third-Party Healthcare Solutions

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Clarity is excited to announce new integration capabilities for third-party healthcare solutions seeking electronic insurance authorization services. As you know, insurance authorizations are a tough challenge for the healthcare industry, as payers require different information sets and processes. Many medical practices struggle to obtain completed and accurate authorizations in a timely manner, resulting in payment denials and high operational costs. The average practice spends 20 hours/week per physician on insurance authorizations due to cumbersome processes, according to Health Affairs. We solved this authorization headache by combining a sophisticated insurance processing platform with a Seattle-based service team to quickly deliver accurate… Read More

Categories: Insurance Authorizations, Clarity News

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What the New Medicare Bill Means for Physicians and Payments

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In a historic bi-partisan bill, President Obama signed legislation on Thursday to end an outdated Medicare payment system, averting a 21 percent physician pay cut. President Obama says the new bill gives physicians assurance on Medicare payments. “It also improves it because it starts encouraging payments based on quality, not the number of tests that are provided or the number of procedures that are applied but whether or not people actually start feeling better,” Obama said. “It encourages us to continue to make the system better without denying service.” While many physicians view the “Doc Fix” bill as a victory,… Read More

Categories: Healthcare Trends, Healthcare Policy

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Uncompensated Care in America: $5.7 Billion Saved, but $40 Billion Still Unpaid

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Since 2000, hospitals have provided more than $459 billion in uncompensated care to their patients, according to the American Hospital Association (AHA). Uncompensated care is an overall measure of hospital care provided for which no payment was received from the patient or insurer. In 2013 alone, hospitals wrote-off $46.4 billion or 5.9 percent of their total expenses. While these numbers are staggering, they are actually an improvement from years past. A projected $5.7 billion drop in uncompensated care for 2014 is expected thanks to the Affordable Care Act, according to the Department of Health and Human Services. (Data for 2014… Read More

Categories: Healthcare Trends, Healthcare Policy, Insurance Authorizations

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Keeping up with Insurance Complexities as the Affordable Care Act Turns Five

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The Affordable Care Act turned five this past week. While opinions are mixed, the numbers are clear – healthcare coverage is expanding: 16.4 million: Number of previously uninsured Americans who have gained coverage under the law, dropping the uninsured rate from 20.3 percent to 13.2 percent. 2.3 million: Number of previously uninsured young adults, ages 19-25, who have gained health insurance through the under 26 provision, which allows them to stay on their parents’ plan. This dropped the uninsured rate for young adults from 34.1 percent to 26.7 percent. With the insured patient population increasing, it is crucial for practices… Read More

Categories: Healthcare Trends, Healthcare Policy, Insurance Authorizations

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Insurance Preauthorizations Overwhelming Practice Staff?

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According to Health Affairs, practices spend over 1000 hours per year per doctor managing insurance preauthorizations. That’s 20 hours a week or half a staff member dedicated to this activity alone per doctor. Across the industry, this adds up to more than $15 billion per year. Why do insurance preauthorizations take up so much staff time? In theory, insurance preauthorizations are obtained prior to a patient’s visit to ensure that the patient is covered and the practice will be paid. However, there are three major roadblocks that prevent practices from obtaining preauthorizations in time or at all: Manual Processes: Each… Read More

Categories: Referral Management

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CMS Threatens to Penalize Medicare Advantage for Inaccurate Provider Directories

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Understanding your insurance coverage is dependent on whether your provider is in-network or out-of-network on your health plan. To make that determination, patients and referring providers rely on insurance payer’s directories to see if the specific provider in question is listed. Simple enough? Not if the directories are out-of-date, an issue that patients and practices have recently run into. Many Medicare Advantage and commercial carriers have made significant changes to their networks of doctors and hospitals over the past few years. In a recent Modern Healthcare article, Medicare beneficiaries say these directories list providers no longer contracted with an Advantage plan… Read More

Categories: Healthcare Trends, Healthcare Policy

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Medicare and UnitedHealth Say Goodbye to Fee-For-Service Medicine

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This week Medicare announced their move away from fee-for-service medicine within four years, outlining a plan to have 50 percent Medicare dollars paid to doctors and hospitals by alternative reimbursement models by 2018. This follows UnitedHealth Group’s announcement last week that they will increase value-based payments by 20 percent in 2015 to “north of $43 billion”. These announcements signal three major shifts to the healthcare industry: Momentum for Healthcare Payment Restructuring: Medicare provides health insurance for 49 million Americans and UnitedHealth Group provides for 84 million Americans, respectively. By making a strong stance towards value-based payments, other private insurers are… Read More

Categories: Coordinated Care, Healthcare Trends

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Tracking Care Coordination: What Healthcare Insurance Reimbursement Reform Means for Healthcare Technology

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While 2014 brought monumental changes to healthcare insurance, 2015 is set to bring even bigger changes to insurance reimbursement. The White House reports that in this past year alone approximately 10 million Americans gained insurance coverage through the Affordable Care Act (ACA). With healthcare coverage adoption rates rising, new insurance payment models continue to evolve towards rewarding “value-based” medicine. But is healthcare technology meeting the needs of providers to provide high-quality coordinated care and tracking to be properly reimbursed? The Emergence of the New Insurance Payment Model In the past year, the ACA set out to identify and promote payment… Read More

Categories: Referral Management

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Introducing Clarity’s New STAT Service, Receive Pre-Authorized Referrals in 30 Minutes or Less

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The Clarity Health team is pleased to announce today our new STAT service for radiology practices will deliver pre-authorized referrals in 30 minutes or less. You can read the full press release here. STAT Service Benefits for Radiologists This unprecedented 30-minute turnaround time will significantly benefit radiology practices and patients, as imaging centers often receive high volumes of walk-in patients, same-day add-on procedures, and last-minute rad protocol changes. Tangible Results   “Not only is Clarity Health’s turnaround time lightning fast, the accuracy and quality of the insurance authorizations delivered are outstanding. By utilizing Clarity’s STAT service, our imaging center can… Read More

Categories: Referral Management

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