Blogs

The Center for Medicare and Medicaid’s (CMS) recent announcement about new eCQM (electronic clinical quality measures) requirements has created a stir among Accountable Care Organizations (ACOs) concerned about scope, implementation, and timeline.

In the context of healthcare, revenue integrity essentially comes down to making sure that each clinical encounter is accurately translated into revenue. In order to achieve this, people, processes, and platforms—all play an important role in realizing operational efficiency, compliance, and optimal reimbursement. In other words, revenue integrity ensures that all patient services are correctly captured, billed, and paid for while ensuring regulatory compliance and an optimal patient experience.

In the context of healthcare, revenue integrity essentially comes down to making sure that each clinical encounter is accurately translated into revenue. In order to achieve this, people, processes, and platforms—all play an important role in realizing operational efficiency, compliance, and optimal reimbursement. In other words, revenue integrity ensures that all patient services are correctly captured, billed, and paid for while ensuring regulatory compliance and an optimal patient experience.

The pandemic has ushered a paradigm shift in healthcare, with the focus on digital technology becoming stronger than ever. For providers, however, accelerating digital transformation in claims management remains a struggle.

By WHO

About half of the United States population is covered by healthcare insurance sponsored by employers, either directly as an employee or as part of an employee’s family, making employers the largest contributors to America’s healthcare insurance sector. From 2011-2021, healthcare costs in the U.S. have risen 50% while healthcare quality and health outcomes remain inferior to comparable countries (OECD).