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Related Experiment Videos

Using case management to improve claims payment.

J A Micheletti1, S Mevert, T J Shlala

  • 1Healthcare Design Systems, Sea Girt, NJ, USA.

Healthcare Financial Management : Journal of the Healthcare Financial Management Association
|April 8, 1995
PubMed
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Healthcare payers are intensifying claim reviews to control costs. Implementing an internal case management program helps providers navigate these reviews and improve claims processing efficiency.

Area of Science:

  • Healthcare Administration
  • Health Services Research

Background:

  • Increasingly intensive claim reviews by payers aim to control healthcare service expenditures.
  • Providers face challenges in understanding and responding to payer review tactics.

Purpose of the Study:

  • To evaluate the effectiveness of internal case management programs in assisting healthcare providers.
  • To identify strategies for streamlining claims processing amidst payer scrutiny.

Main Methods:

  • Analysis of internal case management program implementation.
  • Review of claims processing workflows and payer interaction techniques.

Main Results:

  • Internal case management programs enhance provider comprehension of payer review processes.

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  • Streamlined claims processing and improved response to payer reviews were observed.

    • Conclusions:

    • Internal case management is a valuable tool for providers facing payer claim reviews.
    • Adoption of such programs can lead to more efficient healthcare revenue cycle management.