Here are a few recent bits of rev cycle tech news you may have missed.
With COVID-19 surging, new vaccine approvals, a surprise billing provision added to the new stimulus package, and CMS's price transparency mandate just days away, revenue cycle leaders have a lot on their collective plates.
Here are a few recent bits of rev cycle tech news you may have missed.
1. Integrated billing: New Jersey-based Englewood Health is working with athenahealth and CaduceusHealth for an integrated billing solution. According to the organizations, the work has:
- Enabled Englewood Health to grow from $30 million to $120 million in annual collections, and from 50 to more than 500 providers, between 2011 and 2020
- Boosted patient self-pay from Englewood’s eighth-largest revenue source to its third-largest, behind only Medicare and Blue Cross. When looking at the same set of providers year over year, Englewood saw an 18% increase in collections.
- Allowed Englewood Health to increase its telehealth offering from three to 45 service department practices in five days and implement a remote patient payment application in response to the pandemic.
2. Patient credit options: CareCredit's credit card application and payment option is being added to RevSpring’s PersonaPay payment portal.
CareCredit is a health and wellness credit card accepted at more than 240,000 U.S. healthcare providers, health systems, and retail locations for medical care and other specialties. The CareCredit card also can be used to pay for out-of-pocket expenses including co-pays, coinsurance and deductibles, with promotional financing available on purchases of $200 or more that may not be available with general purpose credit cards.
PersonaPay launched in March.
3. Risk-based contract suite: The SSI Group is partnering with the automated billing solutions firm RCxRules to launch HCC Coding Edit Suite, which aims to help large health systems with risk-based contracts.
The HCC Coding Edit Suite will help identify HCC Coding gaps for coder review, ensuring the capture of accurate and appropriate hierarchical condition category codes, to ensure the Risk Adjustment Factor (RAF) scores align with patient’s health.
4. New acquisition: Cedar Gate Technologies, a value-based care performance management company, has acquired the healthcare data management and analytics firm Deerwalk.
The combined companies will serve payers, providers, employers, and Administrative Services Organizations, including health plans, third-party administrators (TPAs), brokers, consultants and others for value-based care analytics and administration.
5. Automated PBM transactions: The 2019 CAQH Pharmacy Services Index, which was drawn from data from PBMs that represent 65% of all covered lives in the United States found that:
- PBMs conduct 94% of eligibility and benefit verifications electronically
- 75% of pharmacy prior authorizations are fully electronic and use the National Council for Prescription Drug Programs SCRIPT electronic standard for prior authorizations and attachments
- Claim submissions are the most widely adopted, fully electronic transactions reported at nearly 100% for both PBMs (99%) and medical plans (96%)
Alexandra Wilson Pecci is an editor for HealthLeaders.
