In 2020, the Department of Justice estimated that fraudulent, wasteful, and abusive (FWA) billing practices account for more than $100 billion of the nation’s healthcare expenditures.1 Today, the National Healthcare Anti-Fraud Association (NHCAA) conservatively estimates that healthcare FWA costs the nation about $68 billion annually, representing 3% of the nation's $2.26 trillion in healthcare spending.2 FWA estimates from commercial health plans range as high as $230 billion annually, or
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Healthcare Claims
Netsmart Acquires SNF Claims Data Analytics Solution CORE Analytics
What You Should Know: - Netsmart announced that it has acquired CORE Analytics, the industry-leading skilled nursing facility (SNF) claims data analytics offering from Zimmet Healthcare. - With the addition of Core Analytics, Netsmart Simple™is now the only solution suite in the market capable of calculating quality measures and Five-Star ratings leveraging Minimum Data Set (MDS), Payroll-Based Journaling (PBJ) and UB-04 claims data. Software Solutions to Problems in
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Zelis Acquires Healthcare Cost Control Provider Payer Compass
What You Should Know: - Healthcare payments company Zelis today announced an agreement to acquire Payer Compass, a healthcare provider of reimbursement and claims pricing, administration, and processing solutions. Financial terms of the transaction were not disclosed. - Through the acquisition, Zelis will integrate Payer Compass into its existing solution suite to further help clients and their members manage rising healthcare costs and establish more transparent and affordable
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Polygon to Partner with MSP on Healthcare Blockchain Initiative
What You Should Know: - Today, Polygon Networks, a leading blockchain and scaling solution, announced a partnership with Tokenology and MSP Recovery to deliver LifeChain - a new healthcare claims platform. - LifeChain will leverage blockchain technology to solve healthcare's biggest problems, including fraud, inefficiency in payments and antiquated processes. Tokenize Healthcare Claims On-Chain LifeChain will be developed by MSP Recovery and Tokenology as a fully tokenized Medicare,
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Olive Secures $400M At A $4B Valuation to Support New Instant Claim Payment Solution
What You Should Know: - Today, healthcare automation company Olive, today announced a $400M in funding round led by Vista Equity Partners with additional investment from the Base10 Partners Advancement Initiative. Olive, a provider of AI powered workforce purpose-built for healthcare, has now secured $832 million in financing since March 2020, and $902 million since the company’s inception in 2012 bringing the company’s total valuation to $4 billion. - The company plans to use
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4 Quick Tips for Getting COVID-19 Claims Paid Promptly
As the COVID-19 pandemic has gripped the world, many providers have adopted an all-hands-on-deck approach and mentality for treating COVID-19 patients, stretching their resources to the breaking point. We have heard about the frontline heroes who have sacrificed their own health and safety to treat patients and, in less-fortunate scenarios, comfort patients in their last moments as they were quarantined from loved ones. What has been less recognized is the work and sacrifice
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Gleaning Insights for COVID-19: Why Claims and Clinical Data Matter
Healthcare organizations continue to rely heavily on data analytics to try to improve COVID-19 outcomes and public health. Since the novel coronavirus became widespread in the U.S., healthcare data scientists have leveraged clinical and claims data to pinpoint which underlying conditions put patients at higher risk of complications from COVID-19. Health systems are mining clinical data to predict surges in COVID-19 cases and looking at key factors—including increases in hospital website traffic,
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Hospital Sustainability Demands that Revenue Integrity Move Front and Center
Razor-thin operational margins coupled with substantial and ongoing losses related to COVID-19 are culminating in a perfect storm of bottom-line issues for U.S. hospitals and health systems. A study commissioned by the American Hospital Association (AHA) found that the median hospital margin overall was just 3.5% pre-pandemic, and projected margins will stay in the red for at least half of the nation’s hospitals for the remainder of 2020. The reality is that an increase in
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Verisk Acquires MSP Compliance Provider Franco Signor for $160M
What You Should Know: - Verisk acquires Franco Signor, a Bradenton, FL-based full-service provider of MSP compliance software and services for $160M. - Property/casualty insurers, self-insureds, and TPAs will benefit from the most comprehensive suite of fully integrated Medicare compliance solutions and greater access to the nation’s top Medicare experts. Verisk, a data analytics provider, announced today that it has acquired Franco Signor, a Medicare Secondary Payer (MSP) service
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HealthEdge Acquires Payment Integrity Solution The Burgess Group
What You Should Know: - HealthEdge Software announces the acquisition of The Burgess Group, LLC (“Burgess”), an innovative payment integrity software company focused on improving healthcare payment operations for an undisclosed sum. - The strategic acquisition will boost Health Edge’s position in the payment integrity market and extends best-in-class claims processing to include software-driven payment integrity - Burgess’ product, Burgess Source®, is the first solution to natively
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