Becker's Payer Issues | Payer News

Every patient recovering in an inpatient bed who could safely recover at home is a patient in the wrong setting. Meanwhile, a patient in need of acute care waits for a bed. Arlington, Va.-based VHC Health addressed this challenge by…

By the time MLR pressure shows up in your numbers, the margin may already be locked into the quarter. The question is whether you’ll spot the signals early enough to change the outcome. Most health plans don’t recognize margin pressure…

Inpatient CDI has traditionally depended on disruptive retrospective queries, fragmented workflows, and clinicians revisiting the record days or weeks after discharge. What changes when context and documentation guidance arrive during the encounter, while the clinical context is still fresh? Health…

Clinical reviewers open a utilization management or appeals case and spend most of it assembling evidence — hundreds of pages, several source systems and a fax queue that has outlasted every modernization plan built around it. The determination itself is…

In 1987, economist Robert Solow observed that the computer age was visible everywhere except in the productivity statistics. The machines were bought; the work stayed put. The payoff came a decade later, once companies rebuilt around the technology. Revenue cycle…