Insurance / Payer Archives

Read our latest medical billing and RCM related blogs

Negotiating Justifiable Contract with Health Insurance Companies

Care providers operate in an environment characterized by multiple payors – Medicare, Medicaid, and a host of private health plans. The prevalence of such multi-payer is reason enough for differences in rates at which care providers are reimbursed despite the clinical procedures more or less being the same. Adding to this heterogeneous payor-environment is the […]

Navigating Through a Multiple Payer Environment – Providers’ Perspective

Healthcare delivery in the United States of America has come a long way from cash-based to insurance-backed. Currently, over 85% of the nation’s residents have health care plans either through employers’ private pools, private companies, the veterans’ health administration, the children’s health insurance program and Medicare/Medicaid/TRICARE. While insurance payers (whether Federal or private) essentially cover […]

single payer system vermont

Vermont: State with Single payer system “Single-payer health system” which was passed in May 2011 by the Vermont governor, expects to accumulate savings of 24.3% of total health expenditure between 2015 and 2024, according to Harvard economist William Hsiao. Vermont is to be the first state in USA to implement this system, which will move […]

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Better Payer Interaction for Physicians

Payer interaction plays a crucial role in ensuring that physicians receive payments in a fair and timely manner. Medical billers and coders who interact with payers need to stay current with major payers (insurance companies, employers, or the government) in order to make sure that errors and delays can be avoided. The changes in the […]

US Physicians’ Administration Costs Four Times Higher Than Single-payer Healthcare Providers

Going by a recent survey by the researchers with Cornell University and University of Toronto – which has unearthed alarming fact about relatively higher administrative costs in the United States: physician practices incurring nearly $83,000 in administrative costs per physician each year, nearly four times the amount spent by their Canadian counterparts – it is […]

Increased inaccuracy in claims payments by health insurers

Commercial health insurance has registered an increase of 2% over the existing average claims processing error rate of 19.3%. This 2% translates to an extra 3.6 million in erroneous claim payments, and costs an additional estimated $1.5 billion in highly avoidable administrative costs to the health system. AMA (American Medical Association) has released its Fourth […]