Read our experienced team's thought leadership and insight for all areas regarding healthcare claims auditing, payment integrity, provider relations and cost avoidance.
Some of the trends on the horizon this year may be familiar as they’ve been emerging over the years. The healthcare industry is nothing short of a behemoth and although not resistant to change, it can be rather slow to adapt, even when health crises demand it. However, the eruption of COVID-19 in 2020 and the continuation of the pandemic into another year has put pressure on the healthcare industry to make rapid advancements and sharply change direction, in many cases.
Scientists and doctors are constantly innovating to find new and better ways to learn about, treat, or even cure ailments or diseases that affect us. There will always be a newer, possibly better solution on the horizon. However, innovations in healthcare shouldn't be taken for granted. In fact, it's important that we don't think of innovations in health care as expected or able to be achieved with the same players, but rather, encourage those willing to find new solutions to do so.
The impact of the pandemic hasn't been a ripple effect, it's been more like a shockwave to the healthcare industry, insurers and employer health plans (just to name a few in the payer space). It's safe to say no matter who you are, there is an immediate visceral reaction to the impact "Coronavirus" or, "COVID-19" is having on lives, every day. Specifically, the impact on employer sponsored health insurance plans revolves around massive job losses and, although the immediate affect has been staggering, as we enter the second half of 2020, there appears to be some up-ticks in positive notes about the still, very challenging road ahead.
What are the costs for payers, providers and patients in moving towards a historic healthcare price transparency model? We know that payers and providers negotiate specific pricing tiers and strategy regarding both small and complex healthcare visits and procedures, but, what would that look like up-front to the patient?
3 Ways ClaimLogiq is Disrupting the 'Black Box" Model of Claim Auditing Sending claims out for audit and waiting on the results to be delivered without any insight into, or control over, the process, is commonly referred to as the 'black box' model of claims auditing. This is especially true of an often disparate process of reviewing high dollar claims, particularly Itemized bills and DRG validations.