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3 payment integrity imperatives in post-pandemic healthcare

HGS Healthcare leaders identify three main factors behind heightened payment integrity (PI) pressures post-pandemic (i.e., volumes and resources, regulation changes, telehealth) and explain how PI solution experts can help payers reduce those pressures.

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Building a successful data culture in the post-pandemic healthcare reality

HGS Healthcare’s Ramesh Murugesan describes challenges in data science deployments, how to build a healthcare data culture, and the importance of the democratization of data and analytics.

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5 provider coding myths, debunked

Over the past 18 months, healthcare providers have grappled with historic cost and care challenges. The COVID-19 pandemic has increasingly forced providers to assess new areas of transformation to unlock operational value and cost efficiencies.

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Health plan guidance: 3 essentials for no-surprises Act compliance

In recent years, the healthcare industry has increasingly been paying attention to the error rates in health plan directories. Undependable directories create poor member experience by impacting access to care. The Consolidated Appropriations Act COVID-19 relief bill, signed into law on December 27, 2020, requires health plans and healthcare providers to work in tandem, so […]

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The human side of healthcare analytics

A recent study by Tempkin Group showed when individuals have a positive emotional association with a specific brand, they are 8.4 times more likely to trust the company, 7.1 times more likely to purchase more and 6.6 times more likely to forgive a company’s mistake.

Three ways healthcare engagement models differ from other industries

Healthcare engagement models differ from other industries in three ways: compliance needs, customer types, and org structures. A BPO can assist in minimizing differences to truly put customers first.

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For better RCM, prioritize people and track with technology

Proper revenue cycle management (RCM) involves careful documentation of the entire patient journey. Once captured by a proficient employee, patient and member data can be handed over to AI-based systems to reveal insights.

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Preventing and appealing clinical denials with analytics, automation, and AI

U.S. hospitals lose $262 billion due to denied claims each year, representing 10% of the total claims paid. Unraveling the root cause of denials costs an average of $118 for each claim. Applying modern technology — such as analytics, automation, and artificial intelligence (AI) — can help to increase the number of clinical denials investigated, boost appeal effectiveness, and unearth root cause.

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COVID-19 and healthcare: 3 areas of market focus

COVID-19 has heightened the focus on optimized provider data management, utilization management, nurse triage, and telemedicine for payers and providers, both during and after the pandemic subsides.

COVID-19 update

A COVID-19 update from our company’s consulting physician

Throughout 2020 and as we plan for 2021, HGS has trusted the professional insights of Dr. Virginia Gurley, whose steady and reliable point of view has provided us with a sound perspective regarding the pandemic. Her end-of-year statement offers guidance as well as words of encouragement for the months ahead. “COVID-19 has spread by leaps […]

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Member experience: Never a better time for digital enablement

Health plans are all too familiar with the challenges of member experience—that perfect storm of call/processing volume surge, staffing challenges, and critical moment-of-truth engagement pressures. And the stakes are even higher for 2021, according to JD Power research.  The organization’s fourth annual study found that member satisfaction averages dropped from 712 on a 1,000-point scale […]

Precision utilization management: Meeting patients where they are

Providers view prior authorization as a manual, burdensome, and laborious process, mostly because of process missteps such as lack of clinical data integration, inconsistency in data exchange standards, and differing policies among payers. According to a recent American Medical Association survey, handling the surging prior authorization requests translates into a “high” or “extremely high” burden […]

Bridging provider-payer gaps with today’s technology

Across the world, today’s healthcare organizations are sharing one critical challenge: the rising costs associated with improvement in quality care. The underlying mandate is that all stakeholders must keep a sharp focus on making healthcare more effective, efficient, and affordable. To meet this new demand, both payers and providers have made adjustments to service delivery—and […]

4 ways that healthcare systems can manage denied claims

Healthcare systems can better manage denied claims by investing in the front office, improving coding and documentation with technology, improving denial turnaround times, and developing distinct workflows for denials and rejections.

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Healthcare customer engagement: Charting an empathetic experience

At the heart of all great customer engagement strategies is empathy – especially in healthcare. COVID-19 has created an opportunity for a CX reset that fully recognizes customer emotions.

mental health

For a more holistic SDoH picture, look at social determinants of mental health

By Daniel A. Schulte, Senior Vice President, Provider Operations, HGS Healthcare As members of the broader healthcare community, we have been reviewing the many facets of the general healthcare delivery environment: from the old-school “diagnosis and treatment plan” strategy to understanding more about the patient’s real-world constraints on the path to wellness. In addition to […]

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Picking up the pace: Healthcare’s evolution to social media

Healthcare has room to grow in providing a B2C social media experience for members/patients and, for several reasons, should pick up the pace of adoption.

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20/20 vision: 9 trends at the heart of tomorrow’s healthcare

From an in-control consumer to digital experience and telemedicine, healthcare delivery continues to stretch the limits of what we thought possible. As health plans and health systems increasingly turn to outsourcing partners to compete and thrive in this ever-changing market, we’re here with HGS’s on-the-ground assessment of Healthcare 2020. And, at the core of the […]

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Medical credentialing: A safeguard worthy of significant support

By Priyankar Bhattacharya, HGS Senior Manager, Provider Network Operations Today’s healthcare payer and provider organizations are increasingly focusing efforts on physician credentialing for real outcomes such as significant cost savings, turnaround time enhancement, accuracy improvement, and reduced rework. This service area originated in the 1960s, with the Darling v. Charleston Community Memorial Hospital case,  which […]

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Next frontier in healthcare claims automation

By Manjunath, Practice Lead, Claims Adjudication, HGS Claims optimization continues to provide health insurers a key area of opportunity to reduce consistently high loss ratios.  In fact, the U.S. healthcare industry has a significant opportunity to deploy claims automation to save $11.1 billion annually, according to new data released in the fifth annual CAQH Index. […]

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Pre-pay, post-pay, and blended payment integrity: Prevention worth the cure

By Anju Sah, General Manager, Operations; HGS Healthcare Today’s payers are increasingly focusing on optimizing claims management as part of a continuous effort to maximize operational cost savings. In fact, according to Black Book research, fraud management is projected to be one of fastest-growing payer services in the global healthcare BPO services market, with 92% […]

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Pulse check on healthcare delivery transformation

This article was published in IAOP Pulse magazine. By Anand Natampalli, HGS Senior Vice President, Sales and Business Development, Healthcare Blink and you’ll miss the latest landscape shift in healthcare delivery. In terms of affordability, access, digital capabilities, and engagement — consumers are consistently upping the ante. As a result, health plans and health systems such […]

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3 ways collaborative care can drive better outcomes

By Krithika Srivats, Vice President, HGS Healthcare Practice Office  The rising cost of healthcare is dinner-table talk at households across America. And it’s clearly high on the agenda of challenges for payers and providers. In response, there has been a widening scope of emerging analytics and reengineering solutions created primarily to reduce operational effort and […]

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Volume-to-value shift drives surge in demand for revenue cycle management outsourcing

By Dan Schulte, Senior Vice President, HGS Healthcare Today’s providers are walking a fine balance between the push for healthier patient outcomes and unsustainable cost structure. The hospital revenue cycle, in particular, has become complicated in recent years due to several factors, including the adoption of alternative payment models and greater regulatory demand. Macroeconomic headwinds […]

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