With so much of healthcare reimbursement administered by contracts, expected net patient service revenue is often a function of the payment terms and conditions found in payer-provider contracts. In order to identify underpayments, wrongful denials and shortfalls, labs need an effective, automated contract management solution as part of their A/R processes.
We recently attended the American Association of Healthcare Administrative Management (AAHAM) Annual Conference in Las Vegas and brought home a wealth of insight from the interesting conversations with customers, potential customers and industry experts.
Nearly 60% of insured adults have received a surprise bill on a healthcare service they thought was covered by insurance.1 And whether care or the provider is in-network, out-of-network or a mix of the two, 1 in 5 of these insured adults find it difficult to pay their deductibles.2 Why is this happening and what is being done about it?
There are two pathways under the Quality Payment Program (QPP): MIPs and Advanced APMs. Unless you qualify as a participating clinician in an Advanced Alternative Performing Model, MIPS will be your default. MIPS has four weighted performance categories, identified below. This post will focus on Quality and Cost.