Healthcare IT Blogs

Why Prior-Authorization Automation is More Than a Trivial Need for Health Plans?

Claiming for health insurance is a lengthy process. Though patients are not subjected a tedious claim process, the provider and payers are . Prior Authorization is the very first step in the process of claim. This is a permission from the health plans for the payment of the treatment. Without prior authorization some medical treatments…

read more
SMART on FHIR|Healthcare Interoperability Solutions - Nalashaa Healthcare Solutions
How Does SMART on FHIR Promotes the Future of Interoperability?

“Substitutable Medical Applications, Reusable Technologies” AKA SMART is a standard framework to facilitate the development of interchangeable healthcare applications. Since its initiation in 2010, the SMART Health IT Project has attracted the collaboration of many organizations (creating the SMART Advisory Committee). SMART, now is a standard that works on top of FHIR in the same…

read more
edi solutions
Why do Health Plans Need EDI Support?

The benefits of EDI in healthcare is not an alien topic. The healthcare industry is one of the many industries that handle huge volumes of data like —patient medical records, health insurance reimbursements, and healthcare claims, among others. Using paper forms can be cumbersome. Since its inception, EDI systems have been pivotal in helping healthcare…

read more
5 Essential Domains For RPA in Healthcare RCM Automation

Many key aspects of the healthcare revenue cycle have been driven by manual processes that are borderline monotonous. Let’s face it; healthcare providers are having to ‘do more with less’ due to changing healthcare regulations, and much-needed respite is long overdue. In short, the current need of the hour for healthcare providers is effective billing…

read more
Healthcare mobile app development| Healthcare Mobile application development solutions for US Healthcare.
Why Healthcare Should Never Ignore a Mobile App Development Strategy?

A Snapshot of the Mobile Health Market  The mobile health market is predicted to grow at a rate of 41% CAGR in the coming year. Monthly downloads are as high as 3.2 billion across all mobile healthcare apps. A recent statistic also predicts that the mobile healthcare apps market will reach over 11 billion dollars…

read more
healthcare automation solution
Health Plan Automation Solution : RPA, API, BREs, which is ideal for you?

Automation has been at the forefront of technological innovation for quite some time now. Every industry needs automation in one form or another, be it Robotic process automation, industrial automation, APIs, or Business Rules Engine (BREs), it is inevitable for organizations to accomplish day-to-day tasks without leveraging automation.    Health Plans can leverage automation by automating…

read more
OG image healthcare plan 2
Regulatory Solutions That Health Plans Must Choose to Avoid Hefty Penalties

CMS has been releasing a plethora of regulations in the quest to enhance patient care quality. All the players in the healthcare ecosystem have been affected by these regulations; Health Plans are no different. There are certain regulations which takes priority for health plans, as non-compliance may prove too costly for them. Below are regulations…

read more
Future o telehealth | Telehealth solutions – Nalashaa Healthcare Solutions
The Future of Telehealth: All you need to Know

The concept of Telehealth solutions arrived in the late 20th century with the advent of the telephone & radio. Today advanced technologies, including video telephone, the latest telemedical devices, mobile cooperation technology, diagnostic methods, and distributed client or server applications have upgraded the quality of telemedicine and thereby US healthcare in general. It is said that Technology can only improve when…

read more
Population Health Management solution
The Role of Population Health Management in US Healthcare

According to the Centers for Disease Control and Prevention (CDC), population health management (PHM) is “an interdisciplinary, customizable approach that allows health departments to connect practice to policy for change to happen locally.” It helps improve the “Triple aim” moto of the US healthcare industry. Triple aim stands for improving population health, enhancing the patient…

read more
healthcare-cloud-implementation (2)
Cloud Computing in Healthcare: Learn about the Risks and their Possible Solutions

The last three years have accelerated digital evolution in a matter of months. The healthcare industry is facing a sudden need to provide virtual care and remote assistance especially when human contact is restricted. To keep up with these latest trends, legacy systems used across the healthcare industries need urgent modernization. Presently, more organizations in the healthcare…

read more
Healthcare Cloud Engineering
The Latest Trends in Healthcare Cloud Engineering

In the healthcare ecosystem, scalability and information storage are age-old problems. Cloud computing in healthcare provides faster innovation, increased efficiency, better data analytics, higher security, and lower costs. These offer businesses greater scalability and the opportunity to launch new products in real-time. Moreover, the recent pandemic has shown healthcare providers the importance of automation and…

read more
QA for health plans
Quality Assurance for Healthcare Payers: Why is it Needed? 

Quality assurance is one of the pivotal processes that software vendors or end businesses should consider implementing. Policies and care provided to their members aren’t the only concerns for health plans. The system their employees and members use must be quality tested before deployment to avoid irreversible damages.   Claims management is one of the software…

read more
Health plan member engagement solutions and strategies
Here’s How You Can Drive Contextual Member Engagement

Member engagement solutions play a crucial role in the smooth functioning of a health plan. Keeping members happy, satisfied, and healthy works in the favor of both the health plan and the member. With great member engagement solutions comes reduced member dropouts and network leakage, improved care outcomes, and so much more. It also helps…

read more
The Technological Requirements of TEFCA Interoperability

The Trusted Exchange Framework and Common Agreement (TEFCA) was made effective in January 2022. The ONC also provided further clarity on the idea of seamless patient health information exchange in the form of the QHIN Technical Framework (QTF) and the SOP updates to the original TEFCA draft. In this  blog, we’ll take a look at…

read more
Doctors check health of kidneys and urinary system in clinic. Medical study of tiny people with chronic kidney diseases and physiology flat vector illustration. Urology, nephrology, dialysis concept
Digital Healthcare: Countering Chronic Illness with Healthcare IT

“6 out of 10 Adults in the United States have chronic illnesses and 4 out of 10 have two or more.    The Key Lifestyle risks for Chronic Diseases are poor nutrition, lack of adherence to medication, reduced physical activity and excessive alcohol and tobacco use.” – Centers for Disease Control and Prevention  From the statistics above, it…

read more
Health plan member engagement solutions and strategies
Reduce Claims with New and Improved Member Engagement Strategies 

Payers and members make up two-thirds of the healthcare ecosystem and bear the brunt of the care delivered. Undesired care outcomes mean growing inconvenience for the member who has to go back to the provider. For the payer, this means more prior authorization requests, more claims, and ultimately more time and cost spent on one…

read more
Robot handshake human background, futuristic digital age
Healthcare Automation: A Look At The Essential RPA Use Cases in 2022

Make no mistake, Robotic Process Automation (RPA) isn’t anything like the robots you generally see in science documentaries or Sci-fi movies. RPA is all software and it’s remarkably practical and economical enough to be adopted into real-time business applications. However, it also isn’t as complex and ridiculously expensive like the ‘aware’ computer systems that can…

read more
EDI Implementaion challenges
Top 5 Reasons Why Healthcare EDI Implementation is Needed for Providers

In 1991, the Healthcare EDI systems came to existence. Since then, it has been embracing many changes, owing to various updates. Incorporating all the latest updates, healthcare EDI proved to be one of the cornerstone of the Health IT spectrum, especially in the aftermath of the Covid-19 Pandemic.  A few recent studies show that the…

read more
Healthcare analytics solutions to retain provider network
Keep Your Providers Happy With Assistance from Analytic Solutions

A good provider network is essential for payers. Finding new providers and enrolling them into networks is relatively easier than maintaining one. Providers can choose to drop out from health plans for a number of reasons; the reasons are as follows. Delayed Reimbursements Providers often deal with health plans that delay the claim reimbursements even after the…

read more
health plan solutions
Healthcare Payer Solutions: What Needs Your Attention in 2022

Health Plans are one of the most crucial aspects of care for patients. Since health plans have to interact with various parties in the ecosystem, they require a robust software solution to aid them in their journey towards care, compliance and excellent customer service. A robust healthcare payer solution can help health plans make data-driven decisions that…

read more
edi standards for healthcare
All the EDI Standards for Healthcare and their Respective Use-Cases

EDI stands for electronic data interchange. It creates a bridge between computer systems and applications to provide seamless data transfer. This is used by companies to communicate business documents in a standard format. It replaces paper-based documents thus saving time and minimizing errors related to manual processing. Healthcare EDI  In the US healthcare ecosystem, EDI…

read more
No surprises act
The No Surprises Act: What Health Plans Need to Know

According to the first-ever survey conducted in 2020 by on medical debts, 46% of Americans are in medical debt. The number doesn’t seem to be going down, as the next survey conducted showed an increase in the number by 4%. Half of the American population is in debt or having trouble paying off their…

read more
healthcare payers data analytics solutions
Utilize Data Analytics to Reduce Member Dropout

Member management is crucial to healthcare payer organizations. Member engagement KPIs are what decide a payer’s Net Promoter Score. This means that payers must put in extra effort to ensure member attrition is kept to the minimum and ideally eliminated from their health plans.   Members drop out of health plans for a number of…

read more
healthcare payer analytics solution
How Do Analytics Help Reduce Payer’s Burden?

Before we step into how data analytics can transform a payer’s organization for the better, one must address the chains holding them back from the miracles of analytics. The lack of interoperability has been plaguing the healthcare ecosystem for quite some time now. The Interoperability and Patient Access rule along with the Proposals to Reduce Burden,…

read more
Justice. Judge hammer on the table
The TEFCA Updates 2022

The Trusted Exchange Framework and Common Agreement (TEFCA), is the primary constituent in the ONC’s roadmap for nationwide HIT interoperability. Since its introduction in 2018, it has been under review and was only published in the dawning weeks of 2022. TEFCA’s publication brings with it notable changes for HIT developers seeking to transform into Qualified…

read more
Healthcare Interoperability - FHIR
The Various Facets of FHIR

FHIR has taken the healthcare industry by storm. Health plans are rushing to incorporate FHIR into their systems to not just evade penalties but also to attain the end goal of affordable, easily accessible healthcare and healthcare data. In the previous two blogs, we have discussed the origin of FHIR, the need for FHIR, as…

read more
healthcare interoperability solutions
Reducing Burden with FHIR APIs – Part 2

With the latest Interoperability and Patient Access rule, the proposals to reduce provider and patient burden, FHIR-based APIs have become the talk of the town.   The latest proposed rule works towards enhancing health information exchange and achieving appropriate and necessary access to complete health records for patients, providers, and payers. At the same time, CMS is also looking to…

read more
FHIR APIs for Compliance
Reducing Operational Burden with FHIR APIs – Part 1    

  With the introduction of the Interoperability and Patient Access rule, FHIR APIs created quite the buzz within both the payer and the provider communities. As a follow-up to the rule, CMS released a couple of proposals urging payers to implement a few more FHIR-enabled APIs along with the implementation guides.   In this blog, let’s take a look at why these FHIR-enabled APIs were introduced in the…

read more
FHIR - healthcare Interoperability
What’s So Great About FHIR? Find Out Here

Affordable healthcare is the need of the hour and interoperability is the means to that end. The healthcare ecosystem is looking into ways they can enable this affordability as soon as possible, and that is where FHIR comes in. FHR promises an on-demand exchange of secure healthcare information. It has become an increasingly popular protocol, thanks to its commitment to ensuring interoperability in the…

read more
Introduction to FHIR
The Genesis of FHIR

The need for interoperability was first highlighted back in the 1980s when payer organizations had to expand to working with data from more than one system. They needed a foolproof method of exchanging data from one system to another, where both systems could understand and process the data as per requirement. Today, however, the number of systems within a…

read more
Negotiate Provider Contracts
Lost in Provider Management? Here Are a Few Ways Out

In the previous blogs, we’ve covered payment models and the processes involved in provider network management. However, in practical world scenarios, managing a provider network can be tedious and repetitive. In this blog, we shall look at a few of the common challenges that plague health plans when it comes to managing provider networks. We shall also look at a few parameters health plans must-visit while…

read more
Medical workers analyzing electronic record vector illustration. Diagnostic center, medical innovation, modern clinic. Healthcare concept. Creative design for layouts, web pages, banners
Post COVID-19 Care Provider Enablement: The HIT fixes for the Post Pandemic World

The COVID-19 pandemic has disrupted healthcare delivery significantly. Care facilities across the United States sustained financial losses that threaten the viability of medical practices. The unexpected increase in demand for healthcare services has dramatically increased the requirement for specialized care and has exacerbated the clinician burden in the process. Broken interoperability, the lack of value…

read more
Provider Network Management in Healthcare
Here’s What You Need to Know About Provider Network Management

Having provider networks is a necessity. This is true for health plans and providers or hospitals, and especially, for the enrolled members. Managing provider networks can be a lot of work. Identifying the providers and hospitals according to the parameters mentioned in the previous blog is just the tip of the iceberg. The rest of the work essentially needs effective management and maintenance of provider networks. A few of the processes involved in provider network management are as follows. Credentialing and Enrollment   Credentialing is…

read more
Provider Network in Healthcare
Concerned About Setting up a Provider Network? Here’s What You Need to Know.

The healthcare ecosystem consists of three participants:  payer, provider, and members. Payers and providers are constantly rolling out effective, value-based, good quality care for members. There are several ways to achieve this goal, and here we shall delve into one of them – provider networks. A health plan’s provider network is essentially a roster of physicians, be it health providers, or hospitals who are in a contractual relationship with the health plan. These professionals are called in-network providers, and the…

read more
Heart rate on smartwatch. Portable pulse tracker. Wrist clock, watch with touchscreen, healthcare app. Fitness assistant. Gadget for workout. Vector isolated concept metaphor illustration.
EHR and Wearables: The Data Dynamics

The word ‘wearables’ usually brings to the mind, images of fitness devices linked with the smartphone. The birth of these devices accompanied the evolution of mobile devices into significantly more powerful computing platforms. While wearables have established utility in the fitness, gaming, and entertainment industries, their role in healthcare remains less clear. In this blog,…

read more
Challenges on the way to Compliance
Watch Out for these Anchors Holding you Back from Compliance

The proposed rule is currently titled ‘Reducing provider and patient burden’. However, the proposed rules do not promise any reduction of burden for payers. Payers must make sure their systems are updated, along with their workflows to be compliant with the proposal once it does become a rule. As burdens go, here are a few…

read more
Digital health medical technologies service isometric flowchart with clinical care telemedicine online doctor consultation prescription vector illustration
The Healthcare Interoperability Roadmap for 2021

The COVID-19 pandemic is still at large, operating in waves and through transmutation. It appears that its effects are destined to linger for many years to come. While most of these effects have been devastating, the pandemic has had one profound positive effect on the healthcare industry. Federal agencies such as the ONC, FDA and…

read more
Online doctor consultation, diagnostics, advice or support of patient over the internet, video call on mobile phone. Flat design concept healthcare application for website. Medical health service.
Should You Outsource HIT Product Engineering?

The healthcare industry is currently undergoing a radical change driven by patient centricity and the quest for the seamless access and exchange of electronic Patient Health Information (ePHI). Healthcare Information Technology (HIT) and the capabilities it offers for healthcare and payer organizations will determine the success of this vision. The interoperability of healthcare systems and…

read more
Young handsome physician in a medical robe with stethoscope
Electronic Prior Authorization For Medicare Part D – The Essentials

The new CMS mandate for Electronic Prior Authorization (ePA) requests focuses on the NCPDP SCRIPT version 2017071 standard for four electronic Prior Authorization (ePA) transactions. The PA initiation request/response, PA request/response, PA appeal request/response, and PA cancel request/response and prescribers will be required to use this standard when performing ePA transactions for Part D-covered drugs…

read more
Transparency in Coverage Implementation
Here’s How You Can Implement Transparency in Coverage

In the previous blogs, we have defined the Transparency of Coverage rule’s compliance requirements and their corresponding solutions. Now that the expectations from the solution is set, here we are looking at the implementation. Let’s cut straight to it. The implementation approach will depend on various technological factors such as cloud platforms, identification of the right source system with respect to data elements, data quality, etc. Without further ado, let us take a close look at the various dimension required to implement a solution to comply…

read more
HIT 7 Image
The Essential Touchpoints for Care Providers in Preventive Care in 2021

The outbreak of the COVID-19 pandemic presented a unique challenge for care providers. They were handed the daunting task of identifying patients who needed medical attention the most. The burdensome aspect of this challenge was the level of data accuracy needed. One wrong move and the consequences severely affected patient mortality rate.   Care providers have always been strapped…

read more
Doctors and personalized prescriptive analytics. Big data healthcare, personalized medicine, big data patient care, predictive analytics concept. Pinkish coral bluevector isolated illustration
Healthcare Data: The Treasure Trove of Success for Healthcare IT Developers

The healthcare industry is currently undergoing a tectonic shift towards a patient-centric care model to pursue Value-Based Care (VBC). To unearth the ‘value’ in care delivery, care providers must tap into incoming patient data to induce ‘well-informed’ clinical decisions. With this, the fascination for data has grown significantly over the last decade in the US healthcare industry. However,…

read more
Implement Solutions for Transparency in Coverage
Complying with Public Disclosure Requirements

As the dates set for public disclosure requirements, Jan of 2022, draws close with every passing day, it is best for everyone involved if health plans got themselves aligned with these requirements. Compliance would ensure faster delivery of quality care, resulting in reduced visits to the hospital, thereby healthier members. Disclosure requirements for public files…

read more
Transparency in Coverage
Solutions for Transparency in Coverage

The Department’s guidelines on ensuring transparency in coverage are quite elaborate on the context and objective of disclosing information. Our previous blogs outline the disclosure requirements for both the Participants, Beneficiaries, or Enrollees, and the public. However, when disclosure requirements are converted into solutions, complexities arise. Currently, health plans do not have the required information in one place. Even if they do, their Enterprise Data Warehouse (EDW) would…

read more
Blog-RPPB 2-(Proposals-to-reduce burden)-og-no-text
Proposals from the CMS to Reduce Burden

Since the past couple of years, the CMS began its journey to instill interoperability into the healthcare ecosystem and trying to bring about a culture of patient-centricity into the picture. The Interoperability and Patient Access final rule aimed to address the existing drawbacks hampering interoperability and thereby improve the quality of care. However, it missed…

read more
Reducing Provider and Patient Burden
Expanding on Previous Rules to Improve Interoperability and Reduce Burden

Back in May 1, 2020, The Centers for Medicare & Medicaid Services (CMS) introduced the Interoperability and Patient Access Final Rule. The rule aimed to improve healthcare quality provided by improving patients’ access to their healthcare information. By adopting the patient-first approach, CMS believed it would help patients make informed care decisions. While Interoperability and…

read more
Pensioners healthcare expenses. Senile patients treatment, budget finance, health insurance program. Nurse assisting elderly man, retired client. Vector isolated concept metaphor illustration
Exploring the Opportunities to Reduce Cost In Healthcare Operations

Cost is one of the key elements that profoundly influences the efficiency of care delivery operations. Care providers don’t just incur costs when acquiring resources for care delivery. Expenditure is incurred for enabling it also. Healthcare technology is a foundational aspect of enabling care delivery and among the essentials. With the healthcare industry transitioning to…

read more
The Top Five Areas for HIT Developers in IT Management

Provider expectation from HIT vendors has grown exponentially. These expectations encompass data security to application performance and the manageability of IT resources and systems. The good news is, HIT vendors have many avenues to explore to overcome the barriers that prevent care providers from realizing the potential of their technological choices. In this blog, we look at those areas…

read more
Online medical assistance vector illustration. Man using smartphone app for consulting doctor. Male patient chatting with practitioner on internet
The Future of HIT Development: The Top Touchpoints for HIT Developers in Patient Engagement

Patient engagement was initially only a methodology to ramp up the extent of patient satisfaction. With the improvement of healthcare technology, many benefits of patient engagement such as patient safety, transaction efficiency and better-quality care outcomes began to rise to the top. As the healthcare industry aligns itself to ‘patient-centric care’ patient engagement is set to play a leading…

read more
Transparency in Coverage
Uncovering The Drawbacks Hampering Transparency In Coverage 

Access to healthcare is undoubtedly one of the most important factors in leading a well-rounded, healthy life. Although access alone is not enough, healthcare must also be easy to comprehend given that people from all walks of life need to access it. To ensure people are kept in the loop about their healthcare coverage options…

read more
Medics working over charts vector illustration. Medical research, medical development, modern clinic. Healthcare concept. Creative design for layouts, web pages, banners
The Future of HIT Development: The Top Touchpoints for HIT Developers in Financial Administration

Successful reimbursements supplement successful care outcomes. In simple words, when clinicians get paid for their services regularly, the frequency of the medical services amplifies. On the downside, there is no sure-fire way to ensure the quality of care with flawless reimbursements. This is mainly where reimbursement models are undergoing a radical change. Recent CMS regulations have introduced a plethora of changes…

read more
The Future of HIT Clinical
The Future of HIT Development: 10 Touchpoints for EHR Vendors in Clinical Workflow Administration

 EHR systems rose to prominence at an exponential rate since the beginning of the ‘meaningful use’ days in 2009. However, the multitude of contextual changes, mainly driven by perennial regulatory updates, have impeded innovation in EHR development. EHR vendors must restart their innovation engines in the face of evolving reimbursement models, improvements in interoperability standards, rising consumerism and clinician…

read more
Meandering Through Member Engagement: Save Yourselves a Setback

It has been reiterated time and again by the CMS that member engagement is crucial to both the health plans and members. To the health plans, engaging with members contributes to their shared savings, when their members choose a low-cost, high-value service post-consultation. To members, engagement with a payer results in proactive and well-informed healthcare decisions. Keep An Eye Out For These Roadblocks    The…

read more
member engagement-2-overcome-og-1
Driving Member Engagement: A Closer look at Member Journey 

Health Plans are in pursuit of ensuring that members get to choose the best healthcare service which results in better care quality and outcomes. To do so, they are expected to come up with innovative and effective member engagement strategies.  As the term suggests, Member engagement is about interacting with members the right way and at the right time. To gauge the right time and right way, or rather to get the context of the engagement right, Health Plans must keep an…

read more
Digital healthcare gadgets tools software with index finger choosing smartphone screen menu options flat poster vector illustration
The Digital Healthcare Framework for Care Providers: HIT Essentials for 2021 and Beyond

The US healthcare industry is undergoing a tectonic shift towards Value-Based Care (VBC). Changing reimbursement models and HHS regulations are the two primary forces energizing the circumstances. Care providers are caught in this crosswind of a radical industry-wide change. Healthcare Information Technology (HIT) is the buoy that can help them stay afloat and advance towards…

read more
Engage Your Members. It’s Now or Never.

Member engagement is the new trend, taking the healthcare ecosystem by storm. Health Plans are now compelled to make themselves more approachable with enhanced member experience. By definition, member engagement is the interaction health plans have with their members. Traditionally, this interaction was limited to collecting premiums and reimbursing claims. With the onset of mobile applications, however, interactions between…

read more
Tinc Image
Must-share Details with the Public for Improved Transparency

The healthcare industry is witnessing a cultural shift, and aligning business goals along member-centricity. This shift is propelled by both member expectations as well as the plethora of rules and regulations. One such rule is Transparency in Coverage, requiring organizations to divulge cost-sharing details with those concerned, promoting better care decisions. Back in November 2020, ‘The Departments’ released a set of new requirements…

read more
Cloud Application Deployment
Healthcare Cloud Application Deployment: An Overview of The Benefits

The benefits of cloud computing in healthcare need no introduction. Many healthcare facilities in the United States have sampled the power of the cloud. Those who have exhibited excellence in personalized care have also managed to trim operational expenses in the process. As care providers explore healthcare cloud computing in further detail, patients have become acclimatized with quick…

read more
Blog-Continuous-Improvement-OG-wt (1)
Start Your Journey Towards Analytics Excellence

The healthcare revenue ecosystem is always on the move to achieve operational excellence, to offer personalized policies, proactive care programs, and preventive healthcare measures of the best quality. One way to achieve operational excellence is through continually improving the analytics culture, ensuring the data flowing in is utilized the right way to pull off business…

read more
Increased Transparency to Encourage Cost-effective Care Decisions

With the onset of consumerism in healthcare, health plans must be prepared to make adjustments or modifications to IT systems and business processes to include the oncoming set of rules and regulations. Back in November 2020, ‘The Departments’ released a set of new requirements under the Transparency of Coverage rules. ‘The Departments’ consist of the…

read more
Choosing Healthcare Data Services in 2021

Data is the octane that powers the revenue-generating engines of all businesses on Earth. The CMS and ONC understand the possibilities of digitizing and storing high-quality data well, and this explains the ardent push towards a ‘patient-centric’ transformation of US healthcare. Establishing a partnership among patients and care providers is the goal, and it puts the onus on the providers…

read more
Team work process. young business managers crew working with new startup project. labtop on wood table, typing keyboard, texting message, analyse graph plans.
Grow your Payer Business with Prescriptive Analytics

The healthcare industry is going through a makeover where organizations are pushed towards patient-centricity. With the rapidly surging volume of data and care information available online, regardless of the accuracy, patients are demanding access to optimized healthcare delivery. To keep patients satisfied and to stay ahead of the competition, it is high time health plans…

read more
Optimize Payer Business Growth with Predictive Analytics

Descriptive analytics ensures payer organizations are aware of trends in their workflows and key performance indicators (KPIs). Once a deviation within these trends is identified and addressed, stakeholders may need to be updated on the possibility of undesirable events in the future. This is where predictive analytics comes in. It gathers data to come up with event predictions and can notify payers whether their healthcare data management strategies would grant them desirable results. Predictive Analytics in Action   The exponential increase in data…

read more
Improve your Business Performance with Descriptive Analytics

Payer organizations deal with data, day in and day out. It is not enough that payers fulfill their roles in the healthcare revenue ecosystem through claim management, credentialing, code entry, billing, and so on. They need to identify their shortcomings as an organization and address them to achieve higher efficiency, and this is done with the…

read more
Og Image
EHR Use Measures: A Strategy to Counter Clinician Burnout

Clinicians are currently playing the role of superheroes protecting humanity from a vicious enemy, the COVID-19 pandemic. There  appears to be another silent adversary wearing our warriors down. Unfortunately, this enemy exists in the administrative systems that we created to support healthcare and well-being in the first place.    Clinician burnout continues to affect healthcare professionals at a growing rate, and COVID-19…

read more
The Technical Implementaiton of The Cures Act
Technical Implementation of the Cures Act

On December 13, 2016, the 114th United State Congress passed the 21st Century Cures Act with an intention to make it big in the face of U.S Healthcare. While it is designed to accelerate preventive care, health IT development and clinical research, it also intends to encourage data fluidity in the healthcare ecosystem. Recently, through the Cures Act Final Rule, released on May1, 2020, it brought…

read more
Hospital Utilization Management
Utilization Management: Adapting to Pandemic Repercussions

Telehealth services have been the guardian angel of both care providers and patients since the outbreak of the pandemic in 2019. They served as a lifeline for patient triaging and to deliver non-emergency care to chronically ill patients. Care providers’ and patients’ response to telehealth strategies and the extended support for care plans is a shining example of how global communities have adapted…

read more
Report Automation
Improve Payer Reporting Efficiency Through Automation

From member enrollment, eligibility checks, and provider network management to billing and collection, healthcare payers are involved in handling and reporting sensitive healthcare data. The healthcare payer process is drawn out and cumbersome, with human errors resulting in penalties and loss of revenue, and must be automated at all costs. Besides the obvious benefits of report automation, it provides an excellent opportunity for all external stakeholders to view and analyze data efficiently in a customized manner.   Payer Challenges in Absence…

read more
Chronic Care Management Technologies
The Top Technological Avenues for Chronic Care Management in 2021 and Beyond

The COVID-19 pandemic has delivered punishing blows to chronic disease management. Patients enduring pulmonary diseases, hypertension, diabetes, and mental health conditions were among the most impacted. To hold the fort, care providers must utilize remote care platforms and contextually designed engagement to their fullest. But where exactly is the locus of control in Chronic Care Management during the…

read more
Understanding the Limitations of Inadequate Data

Today, data is everywhere and in many forms. The processing power to crunch huge amounts of data and get analytical insights is exponentially increasing. Cloud technologies are boosting the effective utilization of data at a rapid rate. Low-cost storage and on-demand scalability are taking data handling capabilities to new heights. But there is a flip side…

read more
Steps to Success for AI Healthcare
The Steps to Success for Healthcare AI/ML Endeavors

When Deepmind’s AlphaGo defeated Lee Sedol, a top professional Go player, in the year 2016, deep learning (DL), a subset of machine learning (ML), became the buzz word instantly all over the world. After the demonstration of AlphaGo’s DL capabilities, businesses began to assess long term strategies to make serious commitment towards AI/ML implementations. Since then, the experimentations and use cases of implementation of AI/ML…

read more
The CXO Took Kit for HIT Vendors
The CXO Toolkit: Areas of Focus in Healthcare Technology Development in 2021

Since the Meaningful Use initiatives of 2009, Healthcare Information Technology (HIT) development has been driven by continually evolving healthcare regulations. The Interoperability and Patient Access Final Rule & the 21st Century Cures Act Final Rule, released in 2020, continue this trend. HIT’s role in improving care outcomes and managing the pandemic is far too important to…

read more
The Interim Final Rule
The ONC Rule Changed to April 2021 – Act Now to Comply!

The ONC issued a final rule on March 9th, 2020, to hold entities who interfere with, prevent, or materially discourage the access, exchange, or use of electronic health information (ePHI), accountable. It was the Information Blocking final rule, and it affected healthcare providers (Hospitals, SNFs, LTCH, Mental Health Centers, and more), ‘Certified Health IT’ developers, (Certified EHR developers), and HIEs.   The…

read more
Establishing An Analytics Culture
Establishing an Analytics Culture – An Overview of the Roadmap

Although at the beginning of the 21st century, many businesses had started to focus on data, the COVID–19 pandemic has forced organizations to develop and adapt to a must–have data-driven culture at all levels. Data was once a business byproduct for many organizations. Now, data itself is a key driver for decision making in most businesses. Increasingly, many future business decisions will rely on data insights the company gets from its internal and external sources. When the pandemic hit, world economies and organizations went into panic mode because…

read more
The 2021 Physician Fee Schedule - The RPM Updates
The 2021 Physician Schedule – RPM Updates

The 2019 Physician Fee Schedule introduced three new CPT codes (#99453, #99454, and #99457) to enable hospitals and home health agencies to qualify for CMS reimbursements. The CMS’s proposed 2021 Physician Fee Schedule, released in August 2020, adds further clarity to how care providers can use the new CPT codes with the existing ones covering…

read more
The 2020 Changes to ICD-10-CM – What’s New
The 2020 Changes to ICD-10-CM – What’s New?

ICD-10-CM has been used to document inpatient hospital procedure coding since October 1, 2014. It was introduced as an update to ICD-10. The year 2020 introduces two new changes to the coding system.  In this blog, we cover the changes in detail.  In July 2020, the CMS released the 2021 ICD-10-CM Official Guidelines for Coding and Reporting.…

read more
Regulatory penalties
Regulatory Penalties – When the HHS Comes Calling

Millions of citizens in the United States rely on the accuracy of Electronic Health Records (EHR) to make crucial decisions about their well-being. EHR systems are the conduits that host, exchange and retrieve patient health records for clinicians, patients and other dependent institutions that are an integral part of the care continuum. When the integrity…

read more
Digital Patient Experience
Digital Patient Experience – Does it Matter?

 Consumer satisfaction is paramount to the success of the product or service delivered by a business playing the field in the consumer segment. With increasing competition in the healthcare industry, this key performance variable is crucial to how your patients see you as a care provider. The CMS and the ONC continue to push for…

read more
Blog IMage
Descriptive Analytics: Baby steps towards Artificial Intelligence/Machine Learning

We are witnessing a rise in the use of   AI/ML concepts and technologies in healthcare. Today, algorithms are already outperforming radiologists at spotting malignant tumors and guiding researchers to construct cohorts for costly clinical trials. There is also an increasing number of investments being made around AI/ML use cases and proofs-of-concept across the healthcare industry. …

read more
Blog PIC
Integrating Claims and Clinical Data – An Essential for 2020

The health of your organization is directly dependent on the health of the members enrolled with it. A holistic view of your members gives you a complete status of their health, enabling you to decipher future patterns in their healthcare. Such levels of visibility are vital to your profitability/prosperity/growth/organic growth. With excellent insights from the…

read more
What to look for in 2020
Here’s What to Look for in a Healthcare IT Services Company in 2020

Innovations in technology are constant in every industry, and healthcare is no exception to this trend. Healthcare IT (HIT) systems have taken center stage in improving the value of care through meaningful use and the seamless interoperability of patient health information initiatives by the CMS and ONC. HIT vendors must now constantly adapt to regulations without compromising on…

read more
IRF Update
Inpatient Rehabilitation Services Receive a Major Boost from the CMS

The Centre for Medicare and Medicaid Services (CMS) has introduced a final rule to update the Inpatient Rehabilitation Facility (IRF) Prospective Payment System (PPS). The IRF PPS was introduced to cover all the capital costs that IRFs are expected to incur in furnishing intensive inpatient rehabilitation services. The final rule advances the CMS’s vision and…

read more
World with a Mask
Pandemic Management – Time to Evaluate Your Care Process

The outbreak of COVID-19 has sent shockwaves through the healthcare ecosystem, disrupting many vital healthcare services. Most individuals tested positive for COVID-19 now find themselves in the middle of financial turmoil. Others are gripped by confusion and panic, putting a grinding halt to ‘normal life’ as we know it. Care providers are currently caught in…

read more
Streamlining the Science of Patient Cohort Management

Medical researchers and clinicians seek answers to two evocative questions in their line of work. The first one is, “Why do people suffer from a health problem”? The other is, “What exactly determines recovery?” The hunt for these answers has led to the birth of new healthcare domains such as pharmacokinetics, which reveals how medicines interact…

read more
The Cures Act Final Rule – Revisions to CEHRT Development

The 21st Century Cures Act Final rule was introduced on May 1, 2020. It institutes crucial changes to the definition of Certified Electronic Health Record Technology (CEHRT). This means the current standards that define the format of the structured data which EHR systems use are set to change. We will now take a look at…

read more
HIT Vendors, Take Notice

The progress of healthcare technology was primarily driven by the innovative spark of HIT vendors. All great ideas from their research labs and development centers have become a standard in the healthcare industry today. A fine example of this is the integration of data analytics and business intelligence tactics into the Electronic Health Record (EHR)…

read more
Cures Act Final Rule
The 21st Century Cures Act Final Rule Is Here!

Title IV of the 21st Century Cures Act is dedicated to the enablement of easy access to patient health records for care providers, patients, and payers. Interoperability, transparency in reporting, and preventing all efforts directed to blocking access to patient health records a.k.a information blocking make up the nucleus of this section. With the release…

read more
Pandemic Management
Pandemic Management – Your Fight Against COVID-19

Let’s Start with The Bad News COVID -19 has spread to almost every nation in the world since it was first detected in the Wuhan province in China. The United States has over one million cases with  70,000+ deaths and counting. The seemingly ‘intelligent’ behaviour of the virus that causes its meteoric spread before showing…

read more
D365 Second Blog
Dynamics 365 – The Way to True Value-Based Healthcare

The first of this two-blog series on patient-focused healthcare underlines how the US healthcare ecosystem has a lot to be desired from the patient’s perspective. It speaks of how the changing context of the industry is transforming the traditional way of how patients are treated, injecting personalized outreach into the equation. Technological evolution is pivotal…

read more
The Road to Personalized Healthcare – Do More With Less

The goal of a healthcare delivery system that comprises trained professionals, institutions and resources are to meet the health needs of people. The value of care outcomes lies in the ability of clinicians and doctors to understand patient needs and help restore fitness. Its nature makes it a highly specialized system designed to match the…

read more
Case Management: The Unified Approach to Healthcare Delivery

As consumers, we have very distinct and specific preferences. From food to clothing and lifestyle accessories, every choice of an individual is a carefully considered action. Some of the biggest names in e-commerce, hospitality services, consumer electronics and even automotive insurance are now focussing on ‘the individual’. This begs the question. Why should healthcare continue…

read more
Close-up of hands of a nurse typing on laptop
Five Trends that Would Define EHR Development in 2020

Electronic Health Record (EHR) systems have transformed the way doctors and physicians review patient health records. The dawn of EHR systems also gave federal bodies like the CMS an effective tool to promote value-based care by using EHR data as a reference to determine care quality. EHR vendors continue to evolve their products based on…

read more
CJR: A Performance Evaluation and Future Implications

The Comprehensive Care For Joint Replacement (CJR) model was designed to make participant hospitals accountable for both the quality and cost of Lower Extremity Joint Replacements (LEJR) procedures. Hip and knee replacements are two of the most commonly carried out LEJR procedures. With the CJR model, the CMS intended to reward participant hospitals for coordination…

read more
Oncology AI
AI For Oncology: Is it the Missing Link in the War on Cancer?

Artificial Intelligence (AI) has been a prodigious prospect for the healthcare industry for a long time.  AI entails the collection of gargantuan amounts of unstructured data. Developers then need to figure out a way to design an algorithm to sift through all this data and make sense out of it. This exercise yields patterns that…

read more
Vector isometric telemedicine, online medicine healthcare technology concept. 3d illustration with doctor monitoring patient in hospital ward, looking at health indicators at tablet computer screen.
The RPM Trio – A Close Look at the Three New Remote Patient Monitoring CPT Codes

Home health agencies can now report the costs of Remote Patient Monitoring (RPM) services to Medicare for Reimbursement. The latest update to the 2019 Physician Fee Schedule, the RPM reimbursement final rule introduces vital changes in the form of new CPT codes, vastly improving the prospects for telehealth technology.   In 2017, the Centre for Medicare…

read more
Price transparency Rule
The Hospital Price Transparency Rule – Current Industry Situation

The Center for Medicare and Medicaid Services (CMS) has finalized the hospital price transparency rule. The mandate directs care providers to provide patients with a consolidated list of their standard medical services with their costs before admission. The latest attempt from the CMS to standardize healthcare pricing, the hospital price transparency final rule is more…

read more
The Hospital Price Transparency Final Rule is Here!

Citizens of the United States have always been in the dark about the cost of their treatment until the moment they receive the bill for it. This ambiguity can be burdensome, often elevating the stress levels of the patient who is already experiencing the unpleasantries of their medical condition. The Department of Health and Human…

read more
Mobile Electronic health record apps
Is it Time for EHR Vendors to ‘Think Mobile’?

Providing caregivers with mobile functionality increases their frequency of accessing critical patient records. They can use it when performing a wide variety of tasks. From simple tasks like giving out prescriptions to the management of emergencies and complex surgical procedures, mobile devices are always handy during a busy day at the office, doctors say. Unlike traditional…

read more