Payer Relations / en Fri, 25 Apr 2025 20:18:37 -0500 Mon, 24 Feb 25 10:11:51 -0600 Driving Performance Through National Hospital Benchmarking Analytics /education-events/driving-performance-through-national-hospital-benchmarking-analytics <p><strong>Driving Performance Through National Hospital Benchmarking Analytics</strong></p><div class="webreplay"> .webreplay{ border: solid 2px #777; padding: 15px 5px; margin: 0 0 10px 15px; } @media (min-width:360px){ .webreplay{ min-width: 290px; float: right; } } <h2 class="text-align-center"><small>On-demand Webinar</small></h2> MktoForms2.loadForm("//sponsors.aha.org", "710-ZLL-651", 4395);</div><p><strong>Thursday, April 3, 2025 </strong><br><em>2 - 3 p.m. Eastern; 1 - 2 p.m. Central; 11 a.m. - 12 p.m. Pacific</em>  </p><p>How well is your hospital performing relative to peers in your market, and what does “good performance” even look like? To help hospitals identify performance opportunities, this exclusive four-part webinar series unpacks CorroHealth’s proprietary suite of analytics, which leverages national health system datasets and benchmarks to provide actionable insights for hospital leadership. From improving patient status and peer-to-peer (P2P) performance to ensuring accurate CDI/coding and optimizing response to payer denials, each session equips hospital leaders with the tools and knowledge to drive measurable results.  </p><p>Join us to explore cutting-edge analytics that reveal hidden opportunities and empower hospitals to close gaps to “peer best practice” performance levels.</p><p><strong>Attendees Will Learn:</strong></p><ul><li><strong>Industry and “Best Practice” Peer Benchmarking for Success:</strong> Learn how to measure your hospital’s performance against high-performing national and regional peers.  </li><li><strong>Patient Status and P2P Performance:</strong> Discover how to optimize your utilization management (UM) and peer-to-peer strategies. </li><li><strong>CDI Insights:</strong> Understanding your patient mix differences relative to peer hospitals so you can ensure accurate CDI/coding. </li><li><strong>Leverage Advanced Analytics for Denials Management: </strong>Learn how to optimize business office performance and denials resolution using data analytics.  </li></ul><p><strong>Speakers:</strong></p><p>Sam Dominik <br><em>Senior Vice President </em><br><strong>CorroHealth</strong></p><p>Sean Maloney, CFA <br><em>Vice President, Analytics Product Development </em><br><strong>CorroHealth </strong></p> Mon, 24 Feb 2025 10:11:51 -0600 Payer Relations Strategies to Strengthen Hospital Financial Health Amid Payer Pressures Feb 20 /education-events/strategies-strengthen-hospital-financial-health-amid-payer-pressures <p><strong>Strategies to Strengthen Hospital Financial Health Amid Payer Pressures </strong><br><em>A collaboration with Mercy Health to explore effective payer strategies </em> </p><p><strong>Thursday, February 20, 2025 </strong><br><em>2 - 3 p.m. Eastern; 1 - 2 p.m. Central; 11 a.m. - 12 p.m. Pacific   </em><br> </p><div class="webreplay"> .webreplay{ border: solid 2px #777; padding: 15px 5px; margin: 0 0 10px 15px; } @media (min-width:360px){ .webreplay{ min-width: 290px; float: right; } } <h2 class="text-align-center"><small>On-demand Webinar</small></h2> MktoForms2.loadForm("//sponsors.aha.org", "710-ZLL-651", 4339);</div><p><br>Payer denials are a growing challenge for hospitals, putting significant pressure on staff, financial and operational efficiency. In this webinar, CorroHealth and Mercy Health come together to share proven strategies and real-world insights into combating payer denial tactics and how to protect hospitals.  </p><p> </p><p>Join us as we explore actionable frameworks for optimizing denials prevention, leveraging data to prioritize appeals, and ensuring compliance without compromising operational efficiency. Featuring a case study on Mercy Health, this webinar will highlight how proactive approaches, and targeted solutions can drive measurable results for hospitals of all sizes.  </p><p>Whether you're looking to refine your denials management processes or gain new perspectives on navigating payer challenges, this webinar will equip you with the tools to secure financial stability and improve fiscal integrity.</p><p><strong>Attendees Will Learn:</strong></p><ul><li>Key trends in payer denials and their impact on hospitals. Gain insights into the latest payer tactics and learn how to identify denials patterns.  </li><li>Actionable strategies and explore proactive approaches to align leadership, processes and teams.</li><li>How Mercy Health optimized denials management processes. Analyze a real-world case study demonstrating measurable outcomes from targeted denials strategies.  </li><li>How to use advanced analytics to target denials, reduce administrative burdens, and enhance compliance.</li><li>Collaborative solutions to strengthen hospital-payer relationships. Understand how to align internal workflows with payer requirements to secure sustainable financial performance.</li></ul><p><br><strong>Speakers: </strong> </p><p>Jerilyn Morrissey, MD  <br><em>Chief Medical Officer</em> <br><strong>CorroHealth </strong><br><br>Mary Bourland, MD  <br><em>Vice President Coding, CDI and UM  </em><br><strong>Mercy Health </strong><br>Chesterfield, Mo. </p> Fri, 20 Dec 2024 08:46:02 -0600 Payer Relations Aligning Payers and Partners for Value-based Care /2024-10-30/aligning-payers-and-partners-value-based-care <div> </div>header.jumbotron {display:none} <div> /* center_body */ .center_body { /*margin-top:50px;*/ /* margin-bottom: 50px;*/ } .center_body h3 {} .center_body p { font-size: 16px } p.center_Intro { color: #002855; line-height: 1.2em; font-size: 30px; margin: 10px 0 25px 0; font-weight: 700; font-size: 2em; } @media (max-width:768px) { p.center_Intro { line-height: 1.2em; font-size: 23px; font-size: 1.45em; } } .center_body .center_Lead { color: #63666A; font-weight: 300; line-height: 1.4; font-size: 21px; } /* center_body // */ /* Banner_Title_Overlay_Bar */ .Banner_Title_Overlay_Bar { position: relative; display: block; overflow: hidden; max-width: 1170px; margin: 0px auto 25px auto; } .Banner_Title_Overlay_Bar h1 { position: absolute; bottom: 40px; color: #003087; background-color: rgba(255, 255, 255, .8); width: 100%; padding: 20px 40px; font-size: 3em; box-shadow: 0 3px 8px -5px rgba(0, 0, 0, .6); } @media (max-width:991px) { .Banner_Title_Overlay_Bar h1 { bottom: 0px; margin: 0px; font-size: 2.5em; } } @media (max-width:767px) { .Banner_Title_Overlay_Bar h1 { font-size: 2em; text-align: center; text-indent: 0px; padding: 10px 20px; } } @media (max-width:530px) { .Banner_Title_Overlay_Bar h1 { position: relative; background-color: #63666A22; } } /* Banner_Title_Overlay_Bar // */ <header class="Banner_Title_Overlay_Bar"><img src="/sites/default/files/2024-10/KnowEx_CorroHealthh_Medicaid_banner_1170x250.png" alt="Banner Image" width="1170" height="250"><div><h1>Aligning Payers and Partners for Value-based Care</h1></div></header>/* CntMenuSub */ .CntMenuSub{ margin:20px 0px; padding-bottom: 5px; color: #afb1b1; letter-spacing: 1.5px; font-weight: 400; font-size: .7em; } .CntMenuSub .CntMenuBar{ border-bottom: 1px solid lightblue; } .CntMenuSub .CntMenuBar a:after{ content: "|"; padding: 0 3px 0 6px; color: #555; } .CntMenuSub .CntMenuBar a:last-child:after{ content: ""; } .CntMenuSub .CntMenuSubHome, .CntMenuSub .CntMenuSubParent{ text-transform: uppercase; color: #555; opacity: .9; } .CntMenuSub .CntMenuSubParent{ } .CntMenuSub .CntMenuSubChild{ } .CntMenuSub .CntMenuSubCurrent{ opacity: .7; } .CntMenuSub .CntMenuSubHome:hover, .CntMenuSub .CntMenuSubParent:hover{ text-transform: uppercase; color: #d50032; } /* CntMenuSub // */ <div class="container CntMenuSub"><div class="col-md-1"> </div><div class="col-md-10 row CntMenuBar"><a class="CntMenuSubHome" href="/education-events/aha-virtual-executive-dialogues">AHA Knowledge Exchange</a> <span class="CntMenuSubChild" id="CntMenuSubChild">Aligning Payers and Partners for Value-based Care</span></div><div class="col-md-1"> </div></div><div class="row spacer"><div class="col-sm-3"><div><a href="#DownloadFile" target="_blank"><img src="/sites/default/files/2024-10/KnowEx_CorroHealthh_Medicaid_cover_910x1220.jpg" alt="AHA Knowledge Exchange | Aligning Payers and Partners for Value-based Care" width="100%" height="100%"></a></div></div><div class="col-sm-9 center_body">.sponsortype { color: #9d2235; font-size: 1.5em; margin: 0px; font-weight: 700; } <p class="sponsortype">AHA Knowledge Exchange</p> xxxxxx </p> --> Intro.............. </p> --><h2>Hospitals and payers are compelled to align goals and expectations across the care continuum</h2><p>As the health care field adopts value-based care models, hospitals, providers and payers are compelled to align goals and expectations across the care continuum to increase access to evidence-based, preventive and equitable care. Regulatory and market changes are impacting organizations’ value-based care strategies, calling attention to both challenges and opportunities. Data and analytics measure how initiatives influence consumer experience, patient satisfaction, quality and cost of care. This Knowledge Exchange e-book provides insights on how hospital and health system leaders are investing and partnering in this evolving landscape to create sustainable value for their communities.</p><div class="row">@media (min-width:768px){ .EDsponsorFloat{ float:right; } } @media (max-width:767px){ .EDLinkFloat{ position:relative; left:27%; } .EDsponsorFloat { text-align:center } } <div class="col-sm-6"><a class="btn btn-wide btn-primary EDLinkFloat" href="#DownloadFile" title="AHA Knowledge Exchange | Aligning Payers and Partners for Value-based Care" data-view-context="top-level-view">Download the Report</a></div><div class="col-sm-6"><div class="EDsponsorFloat">Sponsored by: <a href="https://corrohealth.com/" target="_blank" rel="noopener nofollow"><img src="/sites/default/files/2024-07/CorroHealth_logo_transparent_834x313.png" alt="CorroHealth Logo" width="100%" height="100%"></a></div></div></div></div></div>.sp_CTA5_holder { margin-top:0px; border-bottom: solid 1px #555; 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font-size: 28px; } .sp_CTA5_section{ margin-top: 25px } .sp_CTA5_ImgShadow { /*background-color:green;*/ /* just a visual */ text-align: center } .sp_CTA5_ImgShadow { padding-bottom:75px; /* must match the padding on the img*/ margin: 0px; } .sp_CTA5_ImgShadow img{ width: calc(100% - 35px - 15px); -webkit-box-shadow: 50px -75px 0px 0px rgba(185, 217, 235, 1); -moz-box-shadow: 50px -75px 0px 0px rgba(185, 217, 235, 1); box-shadow: 50px -75px 0px 0px rgba(185, 217, 235, 1); position: relative; top: 75px; max-width: 490px; } @media (max-width:990px){ .sp_CTA5_ImgShadow img{ max-width: 350px;} } @media (max-width:990px){ .sp_CTA5_ImgShadow { padding-bottom:75px; /* must match the padding on the img*/ margin: 0px; margin-right: 40px } } <div class="row spacer sp_CTA5_holder sp_CTA5_holder_last"><div class="col-md-12"><h3>8 steps hospital and health system leaders are taking toward value-based care</h3><div class="sp_CTA5_section"><ul><li>Determine areas that could benefit from value-based models such as those with lower outcomes, higher costs, and unwarranted variation in process or supplies.</li><li>Align on outcomes measures and benchmarks and carefully formulate and define accountability across systems and partners in value-based contracting.</li><li>Build sufficient volume to support the necessary data analytics, organizational structure and case management function.</li><li>Change workforce culture to support wellness and support care delivered effectively and efficiently outside the hospital.</li><li>Identify clinical champions and incentivize physicians and other providers to improve outcomes and standardize clinical care.</li><li>Engage patients in supporting their own health; work with other community leaders to support a healthier population.</li><li>Strive to better meet the expectations of your patients and the entire community, learning from data and conversations how your hospital is viewed now, and what they wish could be better.</li><li>Identify and use robust analytic strategies and risk-based stratification to understand the critical opportunities to improve community health.</li></ul></div></div></div><h2>Participants</h2>/* people */ .people { margin-top: 50px; } .people img:nth-child(1) { border-radius: 200px; -moz-border-radius: 200px; -webkit-border-radius: 200px; margin-bottom: 10px; max-width:200px; /* for Transformation Talks */ display:block; /* for Transformation Talks */ margin:auto; /* for Transformation Talks */ } .people img:nth-child(1):hover { opacity: .7 } @media (max-width:991px) { .people { margin: auto; } .people p { text-align: center } } .ci_profile { margin-bottom: 30px; display: block; text-align:center /* this is for the "Executive Dialogue" page */ } @media (max-width:991px) { .ci_profile { text-align: center } } .ci_profile p { margin: 0 0 7px 0 } .ci_profile_name { font-weight: 700; font-size: 20px; } p.ci_profile_name { font-size: 1.5em; line-height:1.2em; margin-top:10px } .ci_profile_title { font-style: italic; line-height: 1.3em } .ci_profile_company { font-size: 1em; } p.ci_profile_award { font-size: .8em; text-align:center; color:#55555599; font-weight: 700 } .ci_profile_social { width: auto; } .ci_profile_social i { padding-right: 25px; font-size: 20px } .ci_profile_social a:last-of-type i { padding-right: 0px; } #ci_footer-social { font-size: 1.5em; padding-top: 0px; width: 100%; text-align: right; } @media (max-width:991px) { .ci_logo { margin-top: 25px } .ci_social p { text-align: center !important; } #ci_footer-social { text-align: center } } @media (min-width:769px){ .people .rowEqual_768 { display: -webkit-box; display: -webkit-flex; display: -ms-flexbox; display: flex; flex-wrap: wrap; } .people .rowEqual_768>[class*='col-'] { -ms-flex: 3; /* IE 10 */ flex: inherit; /*flex*/ width: calc((100% / 3) - 2px) /*Adjust % for the number per row, will override the bootstrap - Also needed for Safari*/; } } @media (max-width:767px) and (min-width:361px){ .people .rowEqual_768 { display: -webkit-box; display: -webkit-flex; display: -ms-flexbox; display: flex; flex-wrap: wrap; } .people .rowEqual_768>[class*='col-'] { -ms-flex: 1; /* IE 10 */ flex: auto; width: calc((100% / 2) - 2px) /*Adjust % for the number per row, will override the bootstrap - Also needed for Safari*/; } } p.ci_profile_name { font-size: 1.5em; line-height:1.2em; margin-top:10px } .people .ci_profile_combined{ font-size:14px; line-height: 18px; } .people .ci_profile_combined span{ font-style: italic; } .people .ci_profile_combined:before{ content:""; border-bottom: solid 1px #55555522; display: block; clear: both; width: 85%; margin: 5PX auto 10px; } <div class="people"><div class="row rowEqual_768"><div class="col-md-4 col-sm-6 ci_profile"><img src="/sites/default/files/2024-10/Blaber_Reginald_300x300.png" alt="Reg Blaber" width="300" height="300"><p class="ci_profile_name">Reg Blaber, M.D., MBA</p><p class="ci_profile_title">Executive Vice President and Chief Clinical Officer</p><p class="ci_profile_company">Virtua Health</p></div><div class="col-md-4 col-sm-6 ci_profile"><img src="/sites/default/files/2024-10/Burwell_David_300x300.png" alt="David Burwell" width="300" height="300"><p class="ci_profile_name">David Burwell, M.D., MBA</p><p class="ci_profile_title">Vice President of Medical Affairs and Chief Quality Officer</p><p class="ci_profile_company">UPMC</p></div><div class="col-md-4 col-sm-6 ci_profile"><img src="/sites/default/files/2024-10/Casey_Susan_300x300.png" alt="Susan Bleasdale Casey" width="300" height="300"><p class="ci_profile_name">Susan Bleasdale Casey, M.D., FACP, FIDSA</p><p class="ci_profile_title">Vice President and Chief of Quality and Safety</p><p class="ci_profile_company">University of Maryland Medical Center</p></div><div class="col-md-4 col-sm-6 ci_profile"><img src="/sites/default/files/2024-10/Chessare_John_300x300.png" alt="John Chessare" width="300" height="300"><p class="ci_profile_name">John Chessare, M.D., MPH</p><p class="ci_profile_title">President and CEO</p><p class="ci_profile_company">GBMC HealthCare</p></div><div class="col-md-4 col-sm-6 ci_profile"><img src="/sites/default/files/2024-10/Chung_Jimmy_300x300_0.png" alt="Jimmy Chung" width="300" height="300"><p class="ci_profile_name">Jimmy Chung, M.D., MBA, FACS, CPE</p><p class="ci_profile_title">Chief Medical Officer</p><p class="ci_profile_company">Advantus Health Partners<br>Bon Secours Mercy Health</p></div><div class="col-md-4 col-sm-6 ci_profile"><img src="/sites/default/files/2024-10/Fattig_Marty_300x300.png" alt="Marty Fattig" width="300" height="300"><p class="ci_profile_name">Marty Fattig</p><p class="ci_profile_title">CEO</p><p class="ci_profile_company">Nemaha County Hospital</p></div><div class="col-md-4 col-sm-6 ci_profile"><img src="/sites/default/files/2024-10/Hino_Raymond_300x300.png" alt="Raymond Hino" width="300" height="300"><p class="ci_profile_name">Raymond Hino</p><p class="ci_profile_title">CEO</p><p class="ci_profile_company">Southern Coos Hospital & Health Center</p></div><div class="col-md-4 col-sm-6 ci_profile"><img src="/sites/default/files/2024-10/Kao_Cheng_300x300_0.png" alt="Melinda Muller" width="300" height="300"><p class="ci_profile_name">Cheng-Kai Kao, M.D.</p><p class="ci_profile_title">Chief Medical Information Officer</p><p class="ci_profile_company">UChicago Medicine</p><div class="ci_profile_social"> </div></div><div class="col-md-4 col-sm-6 ci_profile"><img src="/sites/default/files/2024-10/Ketelsen_Carey_300x300_1.png" alt="Carey Ketelsen" width="300" height="300"><p class="ci_profile_name">Carey Ketelsen, RHIA, CRC</p><p class="ci_profile_title">Senior Vice President, Coding Solutions</p><p class="ci_profile_company">CorroHealth</p><div class="ci_profile_social"> </div></div><div class="col-md-4 col-sm-6 ci_profile"><img src="/sites/default/files/2024-10/Koekkoek_Doug_300x300%20%281%29.png" alt="Doug Koekkoek" width="300" height="300"><p class="ci_profile_name">Doug Koekkoek, M.D., FACP, SFHM</p><p class="ci_profile_title">Chief Physician and Clinical Executive</p><p class="ci_profile_company">PeaceHealth</p><div class="ci_profile_social"> </div></div><div class="col-md-4 col-sm-6 ci_profile"><img src="/sites/default/files/2024-10/Merz_Steve_300x300.png" alt="Stephen Merz" width="300" height="300"><p class="ci_profile_name">Stephen Merz, FACHE</p><p class="ci_profile_title">Chief Operating Officer</p><p class="ci_profile_company">Sheppard Pratt Solutions</p><div class="ci_profile_social"> </div></div><div class="col-md-4 col-sm-6 ci_profile"><img src="/sites/default/files/2024-10/Morrissey_Jerilyn_300x300.png" alt="Jerilyn Morrissey" width="300" height="300"><p class="ci_profile_name">Jerilyn Morrissey, M.D.</p><p class="ci_profile_title">Chief Medical Officer</p><p class="ci_profile_company">CorroHealth</p><div class="ci_profile_social"> </div></div><div class="col-md-4 col-sm-6 ci_profile"><img src="/sites/default/files/2024-10/Muna_Esther_300x300.png" alt="Esther Muña" width="300" height="300"><p class="ci_profile_name">Esther Muña, Ph.D., MHA, FACHE</p><p class="ci_profile_title">CEO</p><p class="ci_profile_company">Commonwealth Healthcare Corp.</p><div class="ci_profile_social"> </div></div><div class="col-md-4 col-sm-6 ci_profile"><img src="/sites/default/files/2024-10/Nester_Brian_300x300.png" alt="Brian Nester" width="300" height="300"><p class="ci_profile_name">Brian Nester, D.O., MBA</p><p class="ci_profile_title">President and CEO</p><p class="ci_profile_company">Lehigh Valley Health Network</p><div class="ci_profile_social"> </div></div><div class="col-md-4 col-sm-6 ci_profile"><img src="/sites/default/files/2024-10/Ogden_Lesley_300x300.png" alt="Lesley Ogden" width="300" height="300"><p class="ci_profile_name">Lesley Ogden, M.D., MBA</p><p class="ci_profile_title">CEO</p><p class="ci_profile_company">Samaritan North Lincoln and Pacific Communities Hospitals</p><div class="ci_profile_social"> </div></div><div class="col-md-4 col-sm-6 ci_profile"><img src="/sites/default/files/2024-10/Wilson_James_300x300.png" alt="Jim Wilson" width="300" height="300"><p class="ci_profile_name">Jim Wilson, MBA</p><p class="ci_profile_title">Chief Financial Officer</p><p class="ci_profile_company">Mayo Clinic Health System</p><div class="ci_profile_social"> </div></div><div class="col-md-4 col-sm-6 ci_profile"><img src="/sites/default/files/2024-04/Hoppszallern_Suzanna_300x300%20%281%29.png" alt="Suzanna Hoppszallern" width="300" height="300"><p class="ci_profile_name">Moderator:</p><p class="ci_profile_name">Suzanna Hoppszallern</p><p class="ci_profile_title">Senior Editor, Center for Health Innovation</p><p class="ci_profile_company"> Association</p></div></div></div><div class="raw-html-embed"> .SponsorMarketoForm { background-color: ; padding: 5px 25px; border: solid 2px #307FE2; margin: 50px 15px 0px !important; display: inline-block; width: 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class="resource-wrapper"> <div class="resource-view"> <div class="article views-row"> <div class="views-field views-field-field-page-title-background"> <div class="field-content sed-thumb"> <a href="/member-knowledge-exchange/2024-12-11/resilient-health-system-operating-model" hreflang="en"><img loading="lazy" src="/sites/default/files/styles/small_200x200/public/2024-12/VED_Accenture_Governance_620x381.jpg?itok=viVBuq-l" width="200" height="123" alt="VED_Accenture_Governance_620x381-image" /> </a> </div> </div><div class="views-field views-field-created"> <span class="field-content"><time datetime="2024-12-10T16:11:13-06:00">Dec 10, 2024</time> </span> </div><div class="views-field views-field-title"> <span class="field-content"><a href="/member-knowledge-exchange/2024-12-11/resilient-health-system-operating-model" hreflang="en">The Resilient Health System Operating Model</a></span> </div><div class="views-field views-field-body"> <div class="field-content">Health system leaders are 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hreflang="en">Optimize Your Hospital’s Revenue Cycle for Efficient, Patient-Centered Operations</a></span> </div><div class="views-field views-field-body"> <div class="field-content">Optimizing hospital’s revenue cycle for efficient, patient-centered operations and enhancing critical KPIs using AI and robotic process automation.</div> </div></div> <div class="article views-row"> <div class="views-field views-field-field-page-title-background"> <div class="field-content sed-thumb"> <a href="/2024-11-14/empowering-patient-engagement-and-behavior-change-improve-health-and-reduce-disparities" hreflang="en"><img loading="lazy" src="/sites/default/files/styles/small_200x200/public/2024-11/VED_PatientPoint_Engagement_620x381.jpg?itok=dHKIfRK6" width="200" height="123" alt="PatientPoint_Engagement_620x381" /> </a> </div> </div><div class="views-field views-field-created"> <span class="field-content"><time datetime="2024-11-13T15:51:45-06:00">Nov 13, 2024</time> </span> </div><div class="views-field views-field-title"> <span class="field-content"><a href="/2024-11-14/empowering-patient-engagement-and-behavior-change-improve-health-and-reduce-disparities" hreflang="en">Empowering Patient Engagement and Behavior Change to Improve Health and Reduce Disparities</a></span> </div><div class="views-field views-field-body"> <div class="field-content">Empowering patient engagement and leveraging customized communication and education via digital technologies to improve health and reduce disparities.</div> </div></div> <div class="article views-row"> <div class="views-field views-field-field-page-title-background"> <div class="field-content sed-thumb"> <a href="/2024-10-30/aligning-payers-and-partners-value-based-care" hreflang="en"><img loading="lazy" src="/sites/default/files/styles/small_200x200/public/2024-10/KnowEx_CorroHealthh_Medicaid_620x381.jpg?itok=HS9Y48c8" width="200" height="123" alt="KnowEx_CorroHealth_Medicaid" /> </a> </div> </div><div class="views-field 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</div> </div><div class="views-field views-field-created"> <span class="field-content"><time datetime="2024-09-25T14:49:38-05:00">Sep 25, 2024</time> </span> </div><div class="views-field views-field-title"> <span class="field-content"><a href="/2024-09-26/transforming-behavioral-health-journey" hreflang="en">Transforming the Behavioral Health Journey</a></span> </div><div class="views-field views-field-body"> <div class="field-content">Transforming the behavioral health journey with strategic initiatives to build a sustainable and coordinated behavioral health services continuum.</div> </div></div> </div> </div> <div class="more-link"><a href="/aha-knowledge-exchange-archive">View All: AHA Knowledge Exchange</a></div> </section> </div> </div></div> Tue, 29 Oct 2024 15:17:14 -0500 Payer Relations Denials Deep Dive: Proactive Strategies for Prevention, Appeals, AI and More Dec 4 /education-events/denials-deep-dive-proactive-strategies-prevention-appeals-ai-and-more <p><strong>Denials Deep Dive: Proactive Strategies for Prevention, Appeals, AI and More  </strong></p><p><strong>Wednesday, December 4, 2024    </strong><br><em>1 - 2 p.m. Eastern; noon - 1 p.m. Central; 10 - 11 a.m. Pacific   </em> </p><div class="webreplay"> .webreplay{ border: solid 2px #777; padding: 15px 5px; margin: 0 0 10px 15px; } @media (min-width:360px){ .webreplay{ min-width: 290px; float: right; } } <h2 class="text-align-center"><small>On-demand Webinar</small></h2> MktoForms2.loadForm("//sponsors.aha.org", "710-ZLL-651", 4238);</div><p>It’s a familiar story: Denial rates are rising with no relief in sight. With thousands of health care organizations forced to submit reconsideration letters to secure payment for claims, revenue cycle teams are overwhelmed. So, what proactive steps can you take now to prevent denials while also preparing to manage those that inevitably occur?  </p><p>Find out as we share Mount Sinai’s journey to streamline claims processes and centralize its billing processes, which resulted in a 300% increase in back-office automation, a 14-day average decrease in adjudication and the ability to relocate three full-time employees to higher-value tasks. By utilizing a proactive strategy, Mount Sinai was able to reduce claims denials and improve staff efficiency and satisfaction. Join this webinar to learn how your organization can create cleaner claims, respond to denials with data-driven intelligence and support continuous improvement.</p><p>In just one hour, we’ll cover:  </p><ul><li>The top 10 reasons for denials today.  </li><li>Effective denial prevention tactics, from revealing hidden coverage to tracking claim status. </li><li>Best practices for addressing denials when they arise.</li><li>The future of denial prevention and mitigation.  </li><li> How generative AI can assist with appeals.       </li></ul><h3><small class="sm"><strong>Speaker:</strong></small></h3><p>Judd Chamberlain <br><em>Solution Strategist</em> <br><strong>Waystar </strong></p> Fri, 25 Oct 2024 11:35:14 -0500 Payer Relations Managed Medicaid: Ensuring Quality Health Care Delivery /2024-07-24/managed-medicaid-ensuring-quality-health-care-delivery <div> </div>header.jumbotron {display:none} <div> /* center_body */ .center_body { /*margin-top:50px;*/ /* margin-bottom: 50px;*/ } .center_body h3 {} .center_body p { font-size: 16px } p.center_Intro { color: #002855; line-height: 1.2em; font-size: 30px; margin: 10px 0 25px 0; font-weight: 700; font-size: 2em; } @media (max-width:768px) { p.center_Intro { line-height: 1.2em; font-size: 23px; font-size: 1.45em; } } .center_body .center_Lead { color: #63666A; font-weight: 300; line-height: 1.4; font-size: 21px; } /* center_body // */ /* Banner_Title_Overlay_Bar */ .Banner_Title_Overlay_Bar { position: relative; display: block; overflow: hidden; max-width: 1170px; margin: 0px auto 25px auto; } .Banner_Title_Overlay_Bar h1 { position: absolute; bottom: 40px; color: #003087; background-color: rgba(255, 255, 255, .8); width: 100%; padding: 20px 40px; font-size: 3em; box-shadow: 0 3px 8px -5px rgba(0, 0, 0, .6); } @media (max-width:991px) { .Banner_Title_Overlay_Bar h1 { bottom: 0px; margin: 0px; font-size: 2.5em; } } @media (max-width:767px) { .Banner_Title_Overlay_Bar h1 { font-size: 2em; text-align: center; text-indent: 0px; padding: 10px 20px; } } @media (max-width:530px) { .Banner_Title_Overlay_Bar h1 { position: relative; background-color: #63666A22; } } /* Banner_Title_Overlay_Bar // */ <header class="Banner_Title_Overlay_Bar"><img src="/sites/default/files/2024-07/CorroHealth_Medicaid_banner_1170x250.png" alt="Banner Image" width="1170" height="250"><div><h1>Managed Medicaid: Ensuring Quality Health Care Delivery</h1></div></header>/* CntMenuSub */ .CntMenuSub{ margin:20px 0px; padding-bottom: 5px; color: #afb1b1; letter-spacing: 1.5px; font-weight: 400; font-size: .7em; } .CntMenuSub .CntMenuBar{ border-bottom: 1px solid lightblue; } .CntMenuSub .CntMenuBar a:after{ content: "|"; padding: 0 3px 0 6px; color: #555; } .CntMenuSub .CntMenuBar a:last-child:after{ content: ""; } .CntMenuSub .CntMenuSubHome, .CntMenuSub .CntMenuSubParent{ text-transform: uppercase; color: #555; opacity: .9; } .CntMenuSub .CntMenuSubParent{ } .CntMenuSub .CntMenuSubChild{ } .CntMenuSub .CntMenuSubCurrent{ opacity: .7; } .CntMenuSub .CntMenuSubHome:hover, .CntMenuSub .CntMenuSubParent:hover{ text-transform: uppercase; color: #d50032; } /* CntMenuSub // */ <div class="container CntMenuSub"><div class="col-md-1"> </div><div class="col-md-10 row CntMenuBar"><a class="CntMenuSubHome" href="/education-events/aha-virtual-executive-dialogues">AHA Knowledge Exchange</a> <span class="CntMenuSubChild" id="CntMenuSubChild">Managed Medicaid: Ensuring Quality Health Care Delivery </span></div><div class="col-md-1"> </div></div><div class="row spacer"><div class="col-sm-3"><div><a href="#DownloadFile" target="_blank"><img src="/sites/default/files/2024-07/CorroHealth_Medicaid_cover_910x1220.jpg" alt="AHA Knowledge Exchange | Managed Medicaid: Ensuring Quality Health Care Delivery" width="100%" height="100%"></a></div></div><div class="col-sm-9 center_body">.sponsortype { color: #9d2235; font-size: 1.5em; margin: 0px; font-weight: 700; } <p class="sponsortype">AHA Knowledge Exchange</p> xxxxxx </p> --> Intro.............. </p> --><h2>Data-driven strategies to combat MCO denial tactics</h2><p>Medicaid Managed care enrollment continues to grow, and some Medicaid managed care organizations (MCOs) are limiting access to quality health care for Medicaid enrollees. MCOs play an important role in ensuring that people with Medicaid coverage have access to medically necessary, covered services. The high number and rate of prior authorization delays and denials of care by some MCOs, the limited state oversight of Medicaid MCOs and the limited access to external medical reviews were concerns raised in the July 2023 Department of Health and Human Services Office of Inspector General report. 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} .sp_CTA5_section{ margin-top: 25px } .sp_CTA5_ImgShadow { /*background-color:green;*/ /* just a visual */ text-align: center } .sp_CTA5_ImgShadow { padding-bottom:75px; /* must match the padding on the img*/ margin: 0px; } .sp_CTA5_ImgShadow img{ width: calc(100% - 35px - 15px); -webkit-box-shadow: 50px -75px 0px 0px rgba(185, 217, 235, 1); -moz-box-shadow: 50px -75px 0px 0px rgba(185, 217, 235, 1); box-shadow: 50px -75px 0px 0px rgba(185, 217, 235, 1); position: relative; top: 75px; max-width: 490px; } @media (max-width:990px){ .sp_CTA5_ImgShadow img{ max-width: 350px;} } @media (max-width:990px){ .sp_CTA5_ImgShadow { padding-bottom:75px; /* must match the padding on the img*/ margin: 0px; margin-right: 40px } } <div class="row spacer sp_CTA5_holder sp_CTA5_holder_last"><div class="col-md-12"><h3>9 ways health systems can combat MCO denial tactics</h3><div class="sp_CTA5_section"><ul><li>Use all dispute mechanisms available in your state and, to the extent that existing framework is insufficient, work with hospitals and hospital associations to pursue stronger regulatory protections.</li><li>Support clinical staff engagement with Medicaid agency advisory groups.</li><li>Create public reporting around Medicaid plan performance, e.g., a payer scorecard or annual report that includes data on payment timeliness, denials, appeals, or other accounts receivable trends.</li><li>Start with due diligence internally and review contracts, data and denials at joint operating committee meetings and escalate cases.</li><li>Document first-level denials, appeals, and activity related to prior authorization, including peer-to-peer reviews to gain the support of state Medicaid agencies, legislators, and other government officials.</li><li>Take egregious Medicaid managed care denials to a state fair hearing and push back on upsurges in blanket denials.</li><li>Encourage the state government to pursue health plan accountability, including payer reporting on denials, appeals, peer-to-peer use, and delays in care.</li><li>Provide feedback on your experience with Medicaid plans to state Medicaid officials who are engaged in the MCO procurement process, including inadequate reimbursement, and plan policies and practices that may compromise beneficiary’s access to care.</li><li>Examine whether alternative arrangements, such as direct-to-employer contracting or starting a provider-led health plan, might be a good fit for your organization’s strategic goals to improve health outcomes and reduce cost.</li></ul></div></div></div><h2>Participants</h2>/* people */ .people { margin-top: 50px; 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hreflang="en">Transforming the Behavioral Health Journey</a></span> </div><div class="views-field views-field-body"> <div class="field-content">Transforming the behavioral health journey with strategic initiatives to build a sustainable and coordinated behavioral health services continuum.</div> </div></div> </div> </div> <div class="more-link"><a href="/aha-knowledge-exchange-archive">View All: AHA Knowledge Exchange</a></div> </section> </div> </div></div> Tue, 23 Jul 2024 16:09:39 -0500 Payer Relations Strengthening Financial Performance in Rural Hospitals /member-knowledge-exchange/2024-04-16-/strengthening-financial-performance-rural-hospitals <div> </div>header.jumbotron {display:none} <div> /* center_body */ .center_body { /*margin-top:50px;*/ /* margin-bottom: 50px;*/ } .center_body h3 {} .center_body p { font-size: 16px } p.center_Intro { color: #002855; line-height: 1.2em; font-size: 30px; margin: 10px 0 25px 0; font-weight: 700; font-size: 2em; } @media (max-width:768px) { 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concerns pertaining to access to care, end-to-end visibility of revenue-cycle management performance helps health care organizations prevent claim denials, visualize trends and avoid financial surprises to accelerate reimbursement. Analytics and detailed performance data can pinpoint where revenue processes are missing the mark and need to be adjusted to gain financial visibility for strategic initiatives. Using automation to augment staff capability and streamline workflows can improve morale and productivity and remove friction throughout the patient journey. This knowledge exchange examines the actions that can be taken today to position rural health care organizations for success in the future.</p><div class="row">@media (min-width:768px){ .EDsponsorFloat{ float:right; } } @media (max-width:767px){ .EDLinkFloat{ position:relative; left:27%; } .EDsponsorFloat { text-align:center } } <div class="col-sm-6"><a class="btn btn-wide btn-primary EDLinkFloat" href="#DownloadFile" title="AHA Knowledge Exchange | Strengthening Financial Performance in Rural Hospitals" data-view-context="top-level-view">Download the Report</a></div><div class="col-sm-6"><div class="EDsponsorFloat">Sponsored by: <a href="https://www.inovalon.com/" target="_blank" rel="noopener nofollow"><img src="/sites/default/files/2024-04/Inovalon_StrengtheningFinance_logo_834x313.png" alt="Inovalon Logo" width="100%" height="100%"></a></div></div></div></div></div>.sp_CTA5_holder { margin-top:0px; border-bottom: solid 1px #555; padding-bottom: 50px; } .sp_CTA5_holder_last { border-bottom: solid 0px #555; } .sp_CTA5_holder >div{ overflow: auto; } .sp_CTA5_holder ul { list-style: none; /* Remove default bullets */ padding-left: 0px; /*width: calc(100% - 15%);*/ /*margin: 50px auto 0;*/ margin:auto 50px; } .sp_CTA5_holder ul li{ margin-bottom:7px; line-height: 1.5em; font-size:16px; } .sp_CTA5_holder ul li::before { content: " "; font-size: 1em; margin-right: 10px; display: inline-block; height: 12px; background-color: #9d2235; width: 12px; position: relative; top: 0px; -webkit-transform: rotate(45deg); -moz-transform: rotate(45deg); -o-transform: rotate(45deg); } .sp_CTA5_holder ul li{ padding-left:23px; text-indent:-23px; } .body ol>li, .body ul>li{ font-size:16px: } .sp_CTA5_holder h2 { color: #002855; /*! line-height: 2em; */ font-size: 2.15em; margin: 0 0 15px 0; /*! font-size: 30px; */ } .sp_CTA5_holder h3 { /*color: #002855;*/ line-height: 1em; /*font-size: 1.5em;*/ margin-bottom: 25px; margin-top:5px; font-size: 28px; } .sp_CTA5_section{ margin-top: 25px } .sp_CTA5_ImgShadow { /*background-color:green;*/ /* just a visual */ text-align: center } .sp_CTA5_ImgShadow { padding-bottom:75px; /* must match the padding on the img*/ margin: 0px; } .sp_CTA5_ImgShadow img{ width: calc(100% - 35px - 15px); -webkit-box-shadow: 50px -75px 0px 0px rgba(185, 217, 235, 1); -moz-box-shadow: 50px -75px 0px 0px rgba(185, 217, 235, 1); box-shadow: 50px -75px 0px 0px rgba(185, 217, 235, 1); position: relative; top: 75px; max-width: 490px; } @media (max-width:990px){ .sp_CTA5_ImgShadow img{ max-width: 350px;} } @media (max-width:990px){ .sp_CTA5_ImgShadow { padding-bottom:75px; /* must match the padding on the img*/ margin: 0px; margin-right: 40px } } <div class="row spacer sp_CTA5_holder sp_CTA5_holder_last"><div class="col-md-12"><h3>8 actions rural hospital leaders are taking to improve financial sustainability</h3><div class="sp_CTA5_section"><ul><li>Be transparent about financials with staff, providers, the board, and family and patient advisory committees. Validate and share data and dashboards for better decision-making.</li><li>Look at the big picture. How is your organization doing with regard to budget and key performance indicators like days in accounts receivable, cash on hand and days in cash.</li><li>Promote organizational success as a team effort, squelch department rivalries, and build psychological safety and trust to allow employees to come forward with problems and solutions.</li><li>Find the disconnects among coders, the business office and departments for missed charges, coding errors, claims not filed and first-pass denials.</li><li>Invest in decision-support systems and staff to validate data credibility and evaluate serviceline performance, finetune processes and assess new projects.</li><li>Consolidate and assign staff to specialize in prior authorizations to alleviate clinician burden and minimize delays in care.</li><li>Use outside service providers to fill staffing and expertise gaps as well as outside companies to evaluate revenue processes and uncover problem areas.</li><li>Evaluate electronic health record 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<span class="field-content"><time datetime="2024-11-13T15:51:45-06:00">Nov 13, 2024</time> </span> </div><div class="views-field views-field-title"> <span class="field-content"><a href="/2024-11-14/empowering-patient-engagement-and-behavior-change-improve-health-and-reduce-disparities" hreflang="en">Empowering Patient Engagement and Behavior Change to Improve Health and Reduce Disparities</a></span> </div><div class="views-field views-field-body"> <div class="field-content">Empowering patient engagement and leveraging customized communication and education via digital technologies to improve health and reduce disparities.</div> </div></div> <div class="article views-row"> <div class="views-field views-field-field-page-title-background"> <div class="field-content sed-thumb"> <a href="/2024-10-30/aligning-payers-and-partners-value-based-care" hreflang="en"><img loading="lazy" src="/sites/default/files/styles/small_200x200/public/2024-10/KnowEx_CorroHealthh_Medicaid_620x381.jpg?itok=HS9Y48c8" width="200" height="123" alt="KnowEx_CorroHealth_Medicaid" /> </a> </div> </div><div class="views-field views-field-created"> <span class="field-content"><time datetime="2024-10-29T15:17:14-05:00">Oct 29, 2024</time> </span> </div><div class="views-field views-field-title"> <span class="field-content"><a href="/2024-10-30/aligning-payers-and-partners-value-based-care" hreflang="en">Aligning Payers and Partners for Value-based Care</a></span> </div><div class="views-field views-field-body"> <div class="field-content">As value-based care models grow, hospitals, providers and payers need to align goals and incentives to improve patient outcomes and reduce costs.</div> </div></div> <div class="article views-row"> <div class="views-field views-field-field-page-title-background"> <div class="field-content sed-thumb"> <a href="/2024-09-26/transforming-behavioral-health-journey" hreflang="en"><img loading="lazy" src="/sites/default/files/styles/small_200x200/public/2024-09/Iris-Telehealth-banner-620x381.jpg?itok=QQ9C-7Mp" width="200" height="123" alt="Iris-Telehealth-banner-620x381" /> </a> </div> </div><div class="views-field views-field-created"> <span class="field-content"><time datetime="2024-09-25T14:49:38-05:00">Sep 25, 2024</time> </span> </div><div class="views-field views-field-title"> <span class="field-content"><a href="/2024-09-26/transforming-behavioral-health-journey" hreflang="en">Transforming the Behavioral Health Journey</a></span> </div><div class="views-field views-field-body"> <div class="field-content">Transforming the behavioral health journey with strategic initiatives to build a sustainable and coordinated behavioral health services continuum.</div> </div></div> </div> </div> <div class="more-link"><a href="/aha-knowledge-exchange-archive">View All: AHA Knowledge Exchange</a></div> </section> </div> </div></div> Mon, 15 Apr 2024 18:25:51 -0500 Payer Relations FAQs: Payer Escalations & Strategic Denials Management /education-events/faqs-payer-escalations-strategic-denials-management <p><strong>FAQs: Payer Escalations & Strategic Denials Management </strong> </p><p><strong>Thursday, March 21, 2024   </strong> <br><em>1 - 2 p.m. Eastern; noon - 1 p.m. Central; 10 - 11 a.m. Pacific  </em></p><div class="webreplay"> .webreplay{ border: solid 2px #777; padding: 15px 5px; margin: 0 0 10px 15px; } @media (min-width:360px){ .webreplay{ min-width: 290px; float: right; } } <h2 class="text-align-center"><small>On-demand Webinar</small></h2> MktoForms2.loadForm("//sponsors.aha.org", "710-ZLL-651", 3758);</div><p>This final webinar in our series on payer denial tactics is dedicated to addressing your most frequently asked questions from the previous sessions on payer escalation strategies, diagnosis-related group (DRG) downgrades and denials management. Arm yourself with tested strategies and practical tactics to enhance your organization’s financial health.  </p><p><strong>Attendees Will Learn:</strong></p><ul><li>How to identify the impact of payer tactics and strategies to hold payers accountable.   </li><li>Effective methods for managing DRG downgrades, denials and appeals; leveraging analytics for strategic decision-making; and revenue management.  </li><li>Actionable insights for specific challenges.   </li><li>Answers to frequently asked questions.</li></ul><p><strong>Speakers:</strong></p><p>Jerilyn P. Morrissey, MD <br><em>Chief Medical Officer </em><br><strong>CorroHealth</strong></p><p>Samuel Dominik <br><em>Managing Director, Strategic Advisory Services </em><br><strong>CorroHealth </strong></p> Wed, 07 Feb 2024 09:15:09 -0600 Payer Relations Strategies to Counter Payer Denial Tactics /education-events/strategies-counter-payer-denial-tactics <p><strong>Strategies to Counter Payer Denial Tactics  </strong></p><p><strong>Wednesday, February 28, 2024   </strong><br><em>12 - 1 p.m. Eastern; 11 - 12 p.m. Central; 9 - 10 a.m. Pacific   </em>   </p><div class="webreplay"> .webreplay{ border: solid 2px #777; padding: 15px 5px; margin: 0 0 10px 15px; } @media (min-width:360px){ .webreplay{ min-width: 290px; float: right; } } <h2 class="text-align-center"><small>On-demand Webinar</small></h2> MktoForms2.loadForm("//sponsors.aha.org", "710-ZLL-651", 3666);</div><p>The challenge of navigating payer denials is a critical aspect of hospital revenue optimization. In this webinar, we'll explore innovative strategies to counteract the increasing denial tactics used by Medicare Advantage payers. Learn how to enhance your hospital's financial resilience through strategic approaches in handling denials, implementing effective appeals processes, and leveraging data analytics for more informed decisions. This session will equip health care professionals with the tools to safeguard their revenue in a complex payer landscape.  </p><p><strong>Attendees Will Learn:</strong></p><ul><li>Understanding the landscape of payer denials and their financial impact on health care providers.</li><li>Effective strategies for managing and appealing payer denials.</li><li>Utilizing data analytics to strengthen your hospital's approach to revenue management.</li></ul><p><strong>Speakers:</strong></p><p>Jerilyn P. Morrissey, MD <br><em>Chief Medical Officer </em><br><strong>CorroHealth</strong></p><p>Samuel Dominik <br><em>Managing Director, Strategic Advisory Services </em><br><strong>CorroHealth </strong></p> Thu, 18 Jan 2024 08:38:36 -0600 Payer Relations Impact of Payer Denial Tactics on the Clinical Revenue Cycle /education-events/impact-payer-denial-tactics-clinical-revenue-cycle <p><strong>Impact of Payer Denial Tactics on the Clinical Revenue Cycle  </strong></p><p><strong>Thursday, January 25, 2024  </strong><br><em>12 - 1 p.m. Eastern; 11 - 12 p.m. Central; 9 - 10 a.m. Pacific  </em></p><div class="webreplay"> .webreplay{ border: solid 2px #777; padding: 15px 5px; margin: 0 0 10px 15px; } @media (min-width:360px){ .webreplay{ min-width: 290px; float: right; } } <h2 class="text-align-center"><small>On-demand Webinar</small></h2> MktoForms2.loadForm("//sponsors.aha.org", "710-ZLL-651", 3620);</div><p>Many Medicare Advantage payers run a for-profit business model, and any dollar they can avoid paying providers for care is a dollar they can count toward their profits. In this zero-sum game, your hospital’s revenue integrity strategy needs to evolve at the same velocity as the payers’ payment mitigation strategy.  Join us as we discuss payers' tactics related to DRG integrity, denials and appeals. We’ll explore strategic interventions that are data driven to combat these tactics.  </p><p><strong>Attendees Will Learn:</strong></p><ul><li>The macro-Payer/Provider dynamics in the market and the tactics payers employ on hospitals to maximize their profits.  </li><li>The mechanisms to develop a data-driven approach to identify/quantify the impact payer tactics are having on their organizations and strategies (both internal process-driven and external payer escalation initiatives) to hold payers accountable for appropriate reimbursement.</li></ul><p><br><strong>Speakers:</strong></p><p><br>Jerilyn P Morrissey, MD <br><em>Chief Medical Officer </em><br><strong>CorroHealth</strong></p><p>Samuel Dominik <br><em>Managing Director, Strategic Advisory Services</em> <br><strong>CorroHealth </strong></p> Tue, 12 Dec 2023 14:49:00 -0600 Payer Relations Automating and Streamlining the Claims Management Processes /member-knowledge-exchange/2023-11-08-/automating-and-streamlining-claims-management-processes <div> </div>header.jumbotron {display:none} <div> /* center_body */ .center_body { /*margin-top:50px;*/ /* margin-bottom: 50px;*/ } .center_body h3 {} .center_body p { font-size: 16px } p.center_Intro { color: #002855; line-height: 1.2em; font-size: 30px; margin: 10px 0 25px 0; font-weight: 700; font-size: 2em; } @media (max-width:768px) { p.center_Intro { line-height: 1.2em; font-size: 23px; font-size: 1.45em; } } .center_body .center_Lead { color: #63666A; font-weight: 300; line-height: 1.4; font-size: 21px; } /* center_body // */ /* Banner_Title_Overlay_Bar */ .Banner_Title_Overlay_Bar { position: relative; display: block; overflow: hidden; max-width: 1170px; margin: 0px auto 25px auto; } .Banner_Title_Overlay_Bar h1 { position: absolute; bottom: 40px; color: #003087; background-color: rgba(255, 255, 255, .8); width: 100%; padding: 20px 40px; font-size: 3em; box-shadow: 0 3px 8px -5px rgba(0, 0, 0, .6); } @media (max-width:991px) { .Banner_Title_Overlay_Bar h1 { bottom: 0px; margin: 0px; font-size: 2.5em; } } @media (max-width:767px) { .Banner_Title_Overlay_Bar h1 { font-size: 2em; text-align: center; text-indent: 0px; padding: 10px 20px; } } @media (max-width:530px) { .Banner_Title_Overlay_Bar h1 { position: relative; background-color: #63666A22; } } /* Banner_Title_Overlay_Bar // */ <header class="Banner_Title_Overlay_Bar"><img src="/sites/default/files/2023-11/Inovalon_ClaimsMangement_banner_1170x250.png" alt="Banner Image" width="1170" height="250"><div><h1>Automating and Streamlining the Claims Management Processes</h1></div></header>/* CntMenuSub */ .CntMenuSub{ margin:20px 0px; padding-bottom: 5px; color: #afb1b1; letter-spacing: 1.5px; font-weight: 400; font-size: .7em; } .CntMenuSub .CntMenuBar{ border-bottom: 1px solid lightblue; } .CntMenuSub .CntMenuBar a:after{ content: "|"; padding: 0 3px 0 6px; color: #555; } .CntMenuSub .CntMenuBar a:last-child:after{ content: ""; } .CntMenuSub .CntMenuSubHome, .CntMenuSub .CntMenuSubParent{ text-transform: uppercase; color: #555; opacity: .9; } .CntMenuSub .CntMenuSubParent{ } .CntMenuSub .CntMenuSubChild{ } .CntMenuSub .CntMenuSubCurrent{ opacity: .7; } .CntMenuSub .CntMenuSubHome:hover, .CntMenuSub .CntMenuSubParent:hover{ text-transform: uppercase; color: #d50032; } /* CntMenuSub // */ <div class="container CntMenuSub"><div class="col-md-1"> </div><div class="col-md-10 row CntMenuBar"><a class="CntMenuSubHome" href="/education-events/aha-virtual-executive-dialogues">AHA Knowledge Exchange</a> <span class="CntMenuSubChild" id="CntMenuSubChild">Automating and Streamlining the Claims Management Processes</span></div><div class="col-md-1"> </div></div><div class="row spacer"><div class="col-sm-3"><div><a href="#DownloadFile" target="_blank"><img src="/sites/default/files/2023-11/Inovalon_ClaimsMangement_cover_910x1220.jpg" alt="AHA Knowledge Exchange | Automating and Streamlining the Claims Management Processes: Financial stability strategies amid workforce shortages and reimbursement roadblocks" width="100%" height="100%"></a></div></div><div class="col-sm-9 center_body">.sponsortype { color: #9d2235; font-size: 1.5em; margin: 0px; font-weight: 700; } <p class="sponsortype">AHA Knowledge Exchange</p> Intro.............. </p> --> xxxxxx </p> --><h2>Financial stability strategies amid workforce shortages and reimbursement roadblocks</h2><p>Claims denials, a changing payer landscape and inefficient workflows all contribute to delays in patient care and cash flow slowdowns. From overwhelmed staff to bottlenecks in claims processing, health care leaders are strategizing on how to improve organizational performance and increase patient satisfaction. The future of revenue cycle management relies on process optimization, technology integration, analytics and AI to alleviate the impact of workforce shortages and additional payer requirements. Analytics and detailed performance data can pinpoint where processes are missing the mark and need to be adjusted. This executive dialogue explores how organizations are evaluating and refining current processes and creating an improvement plan to ensure the financial stability of their health system and access to care.</p><div class="row">@media (min-width:768px){ .EDsponsorFloat{ float:right; } } @media (max-width:767px){ .EDLinkFloat{ position:relative; left:27%; } .EDsponsorFloat { text-align:center } } <div class="col-sm-6"><a class="btn btn-wide btn-primary EDLinkFloat" href="#DownloadFile" title="AHA Knowledge Exchange | Automating and Streamlining the Claims Management Processes: Financial stability strategies amid workforce shortages and reimbursement roadblocks" data-view-context="top-level-view">Download the Report</a></div><div class="col-sm-6"><div class="EDsponsorFloat"><strong>Sponsored by: </strong><a href="https://www.inovalon.com/" target="_blank" rel="noopener nofollow"><img src="/sites/default/files/2023-11/Inovalon_logo_transparent_834x313.png" alt="Inovalon Logo" width="100%" height="100%"></a></div></div></div></div></div>.sp_CTA5_holder { margin-top:0px; border-bottom: solid 1px #555; padding-bottom: 50px; } .sp_CTA5_holder_last { border-bottom: solid 0px #555; } .sp_CTA5_holder >div{ overflow: auto; } .sp_CTA5_holder ul { list-style: none; /* Remove default bullets */ padding-left: 0px; /*width: calc(100% - 15%);*/ /*margin: 50px auto 0;*/ margin:auto 50px; } .sp_CTA5_holder ul li{ margin-bottom:7px; line-height: 1.5em; font-size:16px; } .sp_CTA5_holder ul li::before { content: " "; font-size: 1em; margin-right: 10px; display: inline-block; height: 12px; background-color: #9d2235; width: 12px; position: relative; top: 0px; -webkit-transform: rotate(45deg); -moz-transform: rotate(45deg); -o-transform: rotate(45deg); } .sp_CTA5_holder ul li{ padding-left:23px; text-indent:-23px; } .body ol>li, .body ul>li{ font-size:16px: } .sp_CTA5_holder h2 { color: #002855; /*! line-height: 2em; */ font-size: 2.15em; margin: 0 0 15px 0; /*! font-size: 30px; */ } .sp_CTA5_holder h3 { /*color: #002855;*/ line-height: 1em; /*font-size: 1.5em;*/ margin-bottom: 25px; margin-top:5px; font-size: 28px; } .sp_CTA5_section{ margin-top: 25px } .sp_CTA5_ImgShadow { /*background-color:green;*/ /* just a visual */ text-align: center } .sp_CTA5_ImgShadow { padding-bottom:75px; /* must match the padding on the img*/ margin: 0px; } .sp_CTA5_ImgShadow img{ width: calc(100% - 35px - 15px); -webkit-box-shadow: 50px -75px 0px 0px rgba(185, 217, 235, 1); -moz-box-shadow: 50px -75px 0px 0px rgba(185, 217, 235, 1); box-shadow: 50px -75px 0px 0px rgba(185, 217, 235, 1); position: relative; top: 75px; max-width: 490px; } @media (max-width:990px){ .sp_CTA5_ImgShadow img{ max-width: 350px;} } @media (max-width:990px){ .sp_CTA5_ImgShadow { padding-bottom:75px; /* must match the padding on the img*/ margin: 0px; margin-right: 40px } } <div class="row spacer sp_CTA5_holder sp_CTA5_holder_last"><div class="col-md-12"><h3>9 Steps Health Leaders Are Taking to Improve Financial Stability</h3><div class="sp_CTA5_section"><ul><li><strong>Engage and develop the revenue cycle team to be consumer-centric </strong>as part of the patient experience and implement data-driven metrics.</li><li><strong>Track payer changes and reimbursement accuracy with smart dashboards </strong>that send alerts for follow-up care and use these tools to set work priorities.</li><li><strong>Meet with payers to review analytics </strong>and challenge them on how quickly they pay based on billed charges and reimbursement, not on claim volume.</li><li>To decrease denied claims, <strong>put more claim checks on the front end </strong>and use claim scrubbers to verify that CPT codes are accurate.</li><li><strong>Look at first-pass denials </strong>— know the reason for them and build edits — to impact your clean claim rate, improve accounts receivable and decrease work on the back end.</li><li><strong>Use denial analytics </strong>to drill down into location, provider and service by CPT codes to see trends and patterns for better accounts receivable performance and patient experience.</li><li><strong>Optimize the electronic health record from a revenue cycle standpoint </strong>and use integration tools for more accurate documentation.</li><li><strong>Start using artificial intelligence (AI) and robotic process automation </strong>for mundane tasks to free up staff time to do more complicated tasks.</li><li>With revenue processes, <strong>examine lead measures that affect lag measures </strong>and develop a weekly and monthly plan of action to improve those numbers.</li></ul></div></div></div><h2>Participants</h2>/* people */ .people { margin-top: 50px; } .people img:nth-child(1) { border-radius: 200px; -moz-border-radius: 200px; -webkit-border-radius: 200px; margin-bottom: 10px; max-width:200px; /* for Transformation Talks */ display:block; /* for Transformation Talks */ margin:auto; /* for Transformation Talks */ } .people img:nth-child(1):hover { opacity: .7 } @media 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text-align: center } } @media (min-width:769px){ .people .rowEqual_768 { display: -webkit-box; display: -webkit-flex; display: -ms-flexbox; display: flex; flex-wrap: wrap; } .people .rowEqual_768>[class*='col-'] { -ms-flex: 3; /* IE 10 */ flex: inherit; /*flex*/ width: calc((100% / 3) - 2px) /*Adjust % for the number per row, will override the bootstrap - Also needed for Safari*/; } } @media (max-width:767px) and (min-width:361px){ .people .rowEqual_768 { display: -webkit-box; display: -webkit-flex; display: -ms-flexbox; display: flex; flex-wrap: wrap; } .people .rowEqual_768>[class*='col-'] { -ms-flex: 1; /* IE 10 */ flex: auto; width: calc((100% / 2) - 2px) /*Adjust % for the number per row, will override the bootstrap - Also needed for Safari*/; } } p.ci_profile_name { font-size: 1.5em; line-height:1.2em; margin-top:10px } .people .ci_profile_combined{ font-size:14px; line-height: 18px; } .people .ci_profile_combined span{ font-style: italic; } .people .ci_profile_combined:before{ content:""; border-bottom: solid 1px #55555522; display: block; clear: both; width: 85%; margin: 5PX auto 10px; } <div class="people"><div class="row rowEqual_768"><div class="col-md-4 col-sm-6 ci_profile"><img src="/sites/default/files/2023-11/Heithaus_Carolyn_300x300.jpg" alt="Carolyn Heithaus" width="300" height="300"><p class="ci_profile_name">Carolyn Heithaus, MBA</p><p class="ci_profile_title">Executive Vice President of Finance and Chief Financial Officer</p><p class="ci_profile_company">CalvertHealth</p> profile_combined </p> <p class="ci_profile_award"> profile_award </p> <div class="ci_profile_social"> profile_social </div> --></div><div class="col-md-4 col-sm-6 ci_profile"><img src="/sites/default/files/2023-11/Houghton_Marina_300x300.jpg" alt="Marina Houghton" width="300" height="300"><p class="ci_profile_name">Marina Houghton, CPA, CGMA, CVA, CFF, FHFMA</p><p class="ci_profile_title">Vice President of Finance</p><p class="ci_profile_company">Ascension Michigan</p> profile_combined </p> <p class="ci_profile_award"> profile_award </p> <div class="ci_profile_social"> profile_social </div> --></div><div class="col-md-4 col-sm-6 ci_profile"><img src="/sites/default/files/2023-11/Nadler_Tammy_300x300.jpg" alt="Tammy Nadler" width="300" height="300"><p class="ci_profile_name">Tammy Nadler, CPA</p><p class="ci_profile_title">Chief Financial Officer</p><p class="ci_profile_company">Golden Valley Memorial Healthcare</p> profile_combined </p> <p class="ci_profile_award"> profile_award </p> <div class="ci_profile_social"> profile_social </div> --></div><div class="col-md-4 col-sm-6 ci_profile"><img src="/sites/default/files/2023-11/Neal_Kaley_300x300.jpg" alt="Kaley Neal" width="300" height="300"><p class="ci_profile_name">Kaley Neal, MBA, FHFMA, CHFP</p><p class="ci_profile_title">Chief Financial Officer</p><p class="ci_profile_company">Shenandoah Medical Center</p> profile_combined </p> <p class="ci_profile_award"> profile_award </p> <div class="ci_profile_social"> profile_social </div> --></div><div class="col-md-4 col-sm-6 ci_profile"><img src="/sites/default/files/2023-11/Owen_Summer_300x300.jpg" alt="Summer Owen" width="300" height="300"><p class="ci_profile_name">Summer Owen, MBA, CPPS</p><p class="ci_profile_title">Chief Financial Officer</p><p class="ci_profile_company">Great Plains Health</p> profile_combined </p> <p class="ci_profile_award"> profile_award </p> <div class="ci_profile_social"> profile_social </div> --></div><div class="col-md-4 col-sm-6 ci_profile"><img src="/sites/default/files/2023-11/Salwei_Stan_300x300.jpg" alt="Stan Salwei" width="300" height="300"><p class="ci_profile_name">Stan Salwei, MBA</p><p class="ci_profile_title">Director of Revenue Cycle</p><p class="ci_profile_company">Altru Health System</p> profile_combined </p> <p class="ci_profile_award"> profile_award </p> <div class="ci_profile_social"> profile_social </div> --></div><div class="col-md-4 col-sm-6 ci_profile"><img src="/sites/default/files/2023-11/Willis_Danielle_300x300.jpg" alt="Danielle Willis" width="300" height="300"><p class="ci_profile_name">Danielle Willis, CPA, MPA</p><p class="ci_profile_title">Chief Financial Officer / Chief Administrative Officer</p><p class="ci_profile_company">New Orleans East Hospital-LCMC Health</p> profile_combined </p> <p class="ci_profile_award"> profile_award </p> <div class="ci_profile_social"> profile_social </div> --></div><div class="col-md-4 col-sm-6 ci_profile"><img src="/sites/default/files/2023-11/Zindel_Lori_300x300.jpg" alt="Lori Zindl" width="300" height="300"><p class="ci_profile_name">Lori Zindl</p><p class="ci_profile_title">Vice President, Business Development</p><p class="ci_profile_company">Inovalon</p> profile_combined </p> <p class="ci_profile_award"> profile_award </p> <div class="ci_profile_social"> profile_social </div> --></div><div class="col-md-4 col-sm-6 ci_profile"><img src="/sites/default/files/2022-09/Hoppszallern_Suzanna_300x300%20%282%29.jpg" alt="Suzanna Hoppszallern" width="300" height="300"><p class="ci_profile_name">Moderator:<br>Suzanna Hoppszallern</p><p class="ci_profile_title">Senior Editor</p><p class="ci_profile_company"> Association</p> profile_combined </p> <p class="ci_profile_award"> profile_award </p> <div class="ci_profile_social"> profile_social </div> --></div> <img alt="xxxxx" src="/sites/default/files/2021-11/profile_placeholder_300x300.jpg"> <p class="ci_profile_name"> profile_name </p> <p class="ci_profile_title"> profile_title </p> <p class="ci_profile_company"> profile_company </p> <p class="ci_profile_combined"> profile_combined </p> <p class="ci_profile_award"> profile_award </p> <div class="ci_profile_social"> profile_social </div> </div> --></div></div> Moderator </h2> <div class="people"> <div class="row rowEqual_768"> <div class="col-md-4 col-sm-6 ci_profile"> <img alt="Suzanna Hoppszallern" src="/sites/default/files/2022-08/Hoppszallern_Suzanna_300x300.jpg"> <p class="ci_profile_name"> Suzanna Hoppszallern </p> <p class="ci_profile_title"> Senior Editor </p> <p class="ci_profile_company"> Association </p> </div> </div> </div><br> <div class="raw-html-embed"> .SponsorMarketoForm { background-color: ; padding:5px 25px; border: solid 2px #307FE2; margin:50px 15px 0px !important; display:inline-block; width: -webkit-fill-available; margin-bottom:25px; } .SponsorMarketoForm h3{ margin:10x 0 0 0 ; color:#eaaa00; font-size:.7em; text-transform:uppercase; font-weight:400; letter-spacing:3px; max-width:200px; /* Custom for the copy length */ background-color:#fff; padding: 5px 15px; position:relative; top:-35px; height: 0px; } .SponsorMarketoForm h2{ color: #002855; } .SponsorMarketoForm .SponsorMarketoFormHolder{ background-color: ; /*padding:15px;*/ display: inline-block; margin-bottom:25px; } .SponsorMarketoFormHolder form{ margin: auto; } @media (max-width:640px){ 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href="/2024-09-26/transforming-behavioral-health-journey" hreflang="en"><img loading="lazy" src="/sites/default/files/styles/small_200x200/public/2024-09/Iris-Telehealth-banner-620x381.jpg?itok=QQ9C-7Mp" width="200" height="123" alt="Iris-Telehealth-banner-620x381" /> </a> </div> </div><div class="views-field views-field-created"> <span class="field-content"><time datetime="2024-09-25T14:49:38-05:00">Sep 25, 2024</time> </span> </div><div class="views-field views-field-title"> <span class="field-content"><a href="/2024-09-26/transforming-behavioral-health-journey" hreflang="en">Transforming the Behavioral Health Journey</a></span> </div><div class="views-field views-field-body"> <div class="field-content">Transforming the behavioral health journey with strategic initiatives to build a sustainable and coordinated behavioral health services continuum.</div> </div></div> </div> </div> <div class="more-link"><a href="/aha-knowledge-exchange-archive">View All: AHA Knowledge 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