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No Surprises Act: Examining the Independent Dispute Resolution Process

The Final Rule implementing the No Surprises Act provides new guidance for the payor-provider independent dispute resolution (IDR) process. The Final Rule directs certified IDR entities to consider the qualifying payment amount as well as certain other specific factors when resolving out-of-network rate disputes and requires payors to be more transparent about changes to codes or modifiers that...

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No Surprises Act: 4 Key Steps to Providing Good Faith Estimates

The No Surprises Act protects patients from receiving a surprise medical bill by prohibiting balance billing and requiring providers to provide good faith estimates (GFE) of services. A GFE should be provided to all patients who are uninsured and should include all services expected to be provided by both primary and co-providers.While the legislation went into effect on January 1, 2021, HHS did...

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Optimizing Patient and Payor Payments with Patient Responsibility Estimator Tool

In 2021, the total US out-of-pocket healthcare patient spending increased by 10% from the previous year and is expected to continue to increase by 9.9% annually through 20231. An increase in a patient’s financial responsibility is a growing problem in healthcare and is driven by several factors including: Payors shifting a larger portion of the payment to patient responsibility, on average...

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Best Practice to Maximize Patient Collections Now that the HRSA COVID-19 Uninsured Program has Ended

On March 15, 2022, the Health Resources and Services Administration (HRSA) announced that the Uninsured Program would stop accepting claims as it had exhausted its federal pandemic funding. In the COVID-19 Uninsured Program Shutdown FAQs, HRSA stated: Claims submitted after March 22 for COVID-19 testing and treatment, and after April 5 for vaccination will not be adjudicated for payment. ...

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How OmniSYS fits into Your Hospital’s Pharmacy Security Best Practices

Reprinted with permission. When it comes to patient experiences, outpatient hospital pharmacies want the best of the best. To them, the patient’s experience is paramount. But at the end of the day, IT makes the decisions on what solutions are allowed into the hospital network. Because when it comes to security, hospital pharmacies have a distinct set of rules they must follow compared to their...

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3 Ways A Patient Engagement Strategy Makes a Difference for your Pharmacy

Reprinted with permission. It’s 2022. Most pharmacies, no matter their size, have patient messaging software of one sort or another. Everyone sends text messages, makes refill reminder calls, and deploys an IVR. But patient engagement is more than just outbound communication. An effective patient engagement strategy for your pharmacy revolves aroundbi-directional connections that strengthen your...

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Mitigating 2023 Proposed Medicare Reimbursement Cuts

Over the past few years, due to the public health emergency (PHE), Congress has stepped in to halt pending Medicare cuts. However, legislative intervention during the PHE only delayed the cuts until the following year. With the proposed 2023 Medicare Physician Fee Schedule released in July, which contained several reductions, and the return of the 2% sequestration, healthcare providers need to...

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How Real-Time Connectivity Can Drive Revenue, Reduce Cost, and Increase Client Satisfaction

In today’s healthcare environment, there is a lot of uncertainty about what revenue will look like in the face of declining reimbursement, increasing payor denials, and staffing shortages. At the same time, there are greater expectations on the workforce to comply with regulations and payor reimbursement requirements, which can differ by payor and state. Therefore, it is essential for healthcare...

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