Reining in Hospital Supply Costs and Physician Preference Item Spending

Guest post by Definitive Healthcare Supply costs are a primary target of healthcare organizations looking to optimize their operations. Unlike labor and overhead expenses, medical and surgical supply spending is more discretionary and has less immediate impact on clinical care or capacity. In addition, supplies are an increasingly large component of healthcare spending, with the […]

Are Today’s Providers Overwhelmed by Quality Reporting?

Guest post by Definitive Healthcare In today’s healthcare delivery environment, few concerns are as important to providers, payers, and consumers as quality. Quality scores can drive patients towards or away from hospitals and doctors, determine reimbursement rates, and subject organizations to a wide range of government incentives or penalties. Most would agree that quality measurements […]

HCIM Launches the Healthcare Strategic Advisory Council (HSAC)

HCIM Launches the Healthcare Strategic Advisory Council (HSAC)

HealthCare Information Management, Inc. (HCIM), provider of robotic claims automation software and consulting services, has formed the Healthcare Strategic Advisory Council (HSAC), an industry think tank designed to provide insight and guidance related to technology, process improvement, data integration, operational transformation, and regulatory compliance. “The healthcare landscape is evolving at an unprecedented pace and organizations […]

2017 is the Year of the Bot!

2017 is the Year of the Bot!

There’s a strong movement in the corporate world to leverage artificial intelligence and automate workflow decisions. This strategy increases accuracy and lowers the cost of operations, which in turn frees up these companies to further innovate. With the overwhelming pressure for organizations to streamline and be more efficient, robotic process automation will emerge as the […]

HCIM is Your Trusted Resource for EZ-CAP® System Support

Responsiveness and results are critical to the success of your claims operations. HCIM is the only consulting firm with the history, in-depth application knowledge, and the practical hands-on experience to support your EZ-CAP® Benefit Matrix configuration, fee schedule creation and updates, data analytics and report development, project management, and more. For nearly 15 years, we […]

Goodbye Obamacare – Where Do We Go from Here?

Goodbye Obamacare – Where Do We Go from Here?

We’re on the brink of seeing significant shifts in health care with the Republican repeal of the Affordable Care Act. I’m hopeful that we will see wisdom and thoughtfulness in the replacement, but there are fundamental challenges that need to be brought to light as this process goes forward. Health insurance as a for-profit business […]

Transformation from Volume to Value

Transformation from Volume to Value

The industry is responding very slowly to the move to Value-Based Care. Instead of taking steps to move forward with a new model of care delivery and creative payment models, everyone is waiting for the next CMS edict or decision from Congress. The industry should be examining the inefficiencies in the current system, determining how […]

Broadening the Definition of Value in Value-Based Medicine

The healthcare industry needs to broaden the definition of value in value-based medicine. By expanding our view, we’ll discover new and better methods of compensation that incentivize efficiency in medical practice and enhance relationship-based care. Most value-based compensation has been built around clinical outcomes and this is appropriate, but we should also add incentives for […]

Congratulations to Michael Wilson!

We are proud to announce that Michael Wilson, President and CEO of HealthCare Information Management, Inc. has just been elected to the WEDI (Workgroup for Electronic Data Interchange) Board of Directors. This is a two-year term beginning January 1, 2017 and he will serve as a Board Director representing Vendor Organizations. As a Board Director, Michael […]

Michael Wilson Outlines the Data Integration Challenge in Healthcare Tech Outlook Magazine

HCIM President and CEO Michael Wilson provided his insight into the challenge of healthcare data integration in a Healthcare Tech Outlook Magazine article entitled “The New Health Information Integration Challenge – Opportunity or Obstacle?” He explains how healthcare technology companies must find a way to connect payers and providers in an efficient and affordable manner in order […]

HCIM Recognized by CIOReview as one of the 20 Most Promising Productivity Solution Providers in 2016

HCIM Recognized by CIOReview as one of the 20 Most Promising Productivity Solution Providers in 2016

HealthCare Information Management, Inc. (HCIM) announced today that it has been named one of CIOReview’s 20 Most Promising Productivity Solution Providers for 2016. This honor was bestowed to only 20 organizations across all industries in the United States. “Applying innovation and technological expertise, HCIM has developed robotic claims automation solutions that augment their clients’ existing […]

A Call to Purposeful Leadership

A Call to Purposeful Leadership

As a President & CEO, I’m calling on our country’s elected officials to lead with purpose and passion. One of the many values that HCIM’s culture is built upon is the need for “Purposeful Work” and “Purposeful Leadership.” We define Purposeful Work as the need to serve a cause greater than ourselves, to connect with the […]

Increase Office Productivity with Robotic Process Automation

Increase Office Productivity with Robotic Process Automation

People get downright passionate about their favorite productivity hacks because they make life so much more enjoyable, so let me introduce you to mine. You probably already use business software, whether it be Outlook, Exchange, Salesforce, or GoToMeeting. And once they become a part of your daily routine, you couldn’t imagine life without them, right? […]

Leverage technology to uncover hidden ROI in your claims audit process

Leverage technology to uncover hidden ROI in your claims audit process

Many operational errors go undiscovered in the healthcare payer industry. For payers, one of the most costly hidden errors occurs during prepayment claims processing. The magnitude of this problem is significant, as this represents a $2 billion annual expense from costs related to overpayments, rework, provider disturbance, and recovery efforts. Across the payer industry, the […]

Client Spotlight on Northwest Physicians Network

Client Spotlight on Northwest Physicians Network

During a year of rapid growth, Northwest Physicians Network (NPN) doubled the size of their Provider network and drastically increased their membership. With plans to take on one or two more health plans next year, they decided to get ahead of the additional workload by licensing SymKey® to increase their claims auto-adjudication rate through robotic […]

How to Achieve Value-Based Healthcare Transformation

How to Achieve Value-Based Healthcare Transformation

HCIM’s Strategic Consulting mission is to collaborate with healthcare organizations in developing and executing a Value-Based Care Transformation Plan. We utilize a continuous process improvement model and an architectural approach based on medical expense management, appropriate revenue optimization, and administrative cost containment. HCIM’s Value-Based Care Transformation Methodology: Assist with defining a vision for your organization’s […]

SymKey® Wins Most Valuable Processor for Second Year Running

SymKey® Wins Most Valuable Processor for Second Year Running

The SymKey® claims processing stats for 2015 are in and they’re unbelievable. We compiled statistics from 80% of our clients, covering a combined total of over 2.5 million lives. Across these clients, SymKey® touched 7.8 million claims with 5.25 million approved/denied for a 67% completion rate. This represents FTE savings of approximately 264 claims examiners, or […]

Reprocessing Previously Paid Historical Claims can be a Piece of Cake!

Reprocessing Previously Paid Historical Claims can be a Piece of Cake!

Oftentimes claims staff put off the dreaded task of manually reprocessing previously paid claims because it can be difficult and time-consuming. Do you ever run into any of the following problems? CMS makes corrections to the Medicare Physician Fee Schedule (MPFS) and you must retroactively reprocess Medicare fee-for-service claims Members are identified as retroactively termed after the claims were […]

Are You Ready to Transition to Value-Based Healthcare?

The goal of HCIM’s expanded Strategic Consulting unit is to assist organizations with assessing, planning and charting out a future road map to transform their current business model (strategy, operations, medical management and financial stability) to one that ensures they achieve results and realize success in true value-based care. In this video, HCIM President and CEO, […]

Get a Quick and Easy Productivity Boost with Kwik Actions™

Get a Quick and Easy Productivity Boost with Kwik Actions™

Kwik Actions™ is a scaled-down version of SymKey® for Claims that increases the efficiency and productivity of claims operations staff by automating routine tasks. Kwik Actions™ are customized “hotkeys” that users may utilize on demand to perform a predetermined set of screen navigation actions such as keystrokes, mouse clicks, database queries, and interfacing between multiple […]

Back to the Future has Nothing on SymKey<sup>®</sup> Robots!

Back to the Future has Nothing on SymKey® Robots!

2015 came and went, but unfortunately many of the Back to the Future II predictions for life in 2015 have not come to fruition. No self-drying clothes or flying cars. We still have to pump our own gas and locate the closest waste receptacle because robots have not been invented to perform those tasks yet. […]

HCIM’s New Year’s Resolution: Give More!

HCIM’s New Year’s Resolution: Give More!

With the holiday season drawing to a close and the New Year upon us, it’s natural to look back on the last year and reflect on things we’ve done well and identify some areas where improvement might be necessary. It’s an opportunity to look forward to the coming year and visualize what you plan to […]

CIOReview Selects HCIM as 2015’s 50 Most Promising Healthcare Tech Solution Providers

CIOReview Selects HCIM as 2015’s 50 Most Promising Healthcare Tech Solution Providers

HCIM was honored as one of 2015’s Top 50 Most Promising Healthcare Tech Solution Providers for its cost-effective and flexible technology solutions for healthcare payers and managed care organizations HealthCare Information Management, Inc. (HCIM) was selected as one of the nation’s 50 Most Promising Healthcare Tech Solution Providers by CIOReview, based on HCIM’s innovative automation […]

HCIM Launches a Strategic Consulting Practice Focusing on Healthcare Transformation

HCIM Launches a Strategic Consulting Practice Focusing on Healthcare Transformation

WALNUT CREEK, Calif., Nov. 18, 2015 — HealthCare Information Management, Inc. (HCIM) is announcing the expansion of its consulting service offerings to include a Strategic Consulting Practice focusing on navigating the future transformation of the healthcare marketplace. This new initiative is driven by two industry executives with over 75 years of combined healthcare operations and technology experience […]

HCIM Puts Thanks into Action by Providing Thanksgiving Meals

HCIM Puts Thanks into Action by Providing Thanksgiving Meals

While most celebrate Thanksgiving by enjoying a bountiful harvest surrounded by warmth and loved ones, it’s important to remember those who are less fortunate. HCIM’s commitment to providing for those in need is central to our corporate culture. In order to put our thanks into action, HCIM made a donation to a local food bank […]

Heritage Provider Network Leverages SymKey® Enterprise License

Heritage Provider Network (HPN) is utilizing a SymKey® Enterprise License for all seven of their sites which includes the use of all SymKey® modules (Professional, Hospital, Virtual Auto-Post™) and unlimited processing engines for increased productivity. “We’re looking for whatever we can do to automate our business processes accurately and without errors. The less we can […]

New Virtual Examiner<sup>®</sup> and Claims Audit Tool<sup>™</sup> Solution Suite Featuring SymKey<sup>®</sup> Automation

New Virtual Examiner® and Claims Audit Tool Solution Suite Featuring SymKey® Automation

This past July, a large Medicaid health plan licensed the Virtual Examiner® (VE) and Claims Audit Tool™ (CAT) solution featuring SymKey® Virtual Auto-Post™ (VAP) automation for the QNXT™ claims system. This cost-effective integrated solution will help the client to realize potentially millions of dollars in overpayment and rework savings, and generate significant ROI. It will […]

HCIM’s 15 Days of Giving: The Results Are In

HCIM’s 15 Days of Giving: The Results Are In

July 2015 marks 15 Years for HCIM and we’re celebrating! As our way of saying Thank You to all those who have contributed to our success, HCIM Colleagues and Clients had the opportunity to vote once per day for the past 15 days for their favorite of 15 featured charities. Due to a tie for […]

HCIM Commemorates 15 Years of Optimizing Healthcare Claims Operations

HCIM Commemorates 15 Years of Optimizing Healthcare Claims Operations

WALNUT CREEK, Calif., July 1, 2015 — HealthCare Information Management, Inc. (HCIM) is celebrating its milestone 15th anniversary this month. As a premier provider of healthcare claims business process automation solutions and managed care/payer consulting services, HCIM has built a solid reputation of ingenuity, innovation, and integrity. “We really focus on building long, enduring relationships with […]

The Journey: Celebrating HCIM’s Past 15 Years

The Journey: Celebrating HCIM’s Past 15 Years

HealthCare Information Management, Inc. (HCIM) is celebrating its 15-year anniversary this July and we couldn’t be prouder. How did we make it this far? Well, let me start at the beginning. Do you remember Y2K? If you do, you probably recall the widespread panic relating to all things tech due to the Y2K bug that […]

Innovative Post-Payment SymKey® Uses

Innovative Post-Payment SymKey® Uses

HCIM’s SymKey® clients are able to automate the post-payment reprocessing of claims in order to handle large volumes of claims without the need to hire additional claims staff. Some of these post-payment uses include: Applying CMS retroactive fee schedule changes Applying retroactive Provider contract fee schedule changes Identifying/correcting ineligible Providers/Vendors for services Correcting member eligibility […]

SymKey Wins 2014 Most Valuable Processor (MVP)

SymKey Wins 2014 Most Valuable Processor (MVP)

HCIM’s flagship SymKey® business process automation solution has had another banner year of processing professional and hospital claims. To see what kind of impact SymKey® had in 2014, we compiled statistics in a limited survey of 18 of our SymKey® clients. We found that for these clients alone in 2014, SymKey® achieved a return on investment […]

Top 10 Claims Audit Best Practices

Top 10 Claims Audit Best Practices

The Need for Increased Payment Accuracy With U.S. healthcare claims processing and payment error rates ranging from 7-10% and administrative costs to reconcile those errors exceeding $7 billion, there’s plenty of room for improvement and a significant savings opportunity for those organizations looking to improve their claims audit process. Top 10 Claims Audit Best Practices […]

The Lost Art of Doing Business Face-to-Face: Part 2

The Lost Art of Doing Business Face-to-Face: Part 2

Don’t get me wrong, I still believe in emails and phone calls as an effective communication tool. But meeting face-to-face is also necessary to ensure effective and open communication. In my previous blog, I talked about the importance of face-to-face meetings. But I think it’s important to differentiate the advantages of in-person meetings vs. technology-enabled […]

The Lost Art of Doing Business Face-to-Face: Part 1

The Lost Art of Doing Business Face-to-Face: Part 1

I wanted to title this blog “You can’t shake hands in a virtual meeting” because we seem to have lost the art of doing business face-to-face. In this brave new world of technological conveniences, business communication has become dominated by emails, cell phone conversations, and text messages. But what about the handshake? I believe in the inherent […]

SymKey’s Reprocess/Pend scenario is a perfect automated solution for adjusting paid EZ-CAP claims 6-10x faster than manually

The SymKey® Reprocess/Pend scenario (available via a query or TXT file) reprocesses EZ-CAP® status 9 paid claims by duplicating the claim and all detail lines, adjusting the original net pay of each line, re-pricing each claim line, adding a Processing Status note to reference the original claim, and then pending the duplicated claim to status […]

Tuality Health Alliance Leverages Integrated Suite of Automated Solutions

Tuality Health Alliance (Tuality) is a physician-hospital community organization that contracts with over a dozen health plans. Their physician membership includes approximately 80 primary-care physicians and 200 specialists. Tuality went live with SymKey® for Plexis Claims Manager™ in mid-July, 2014. Within the first month, they were processing an average of 400 claims per hour with […]

CIOReview Selects HCIM as 2014’s 20 Most Promising Healthcare Consulting Providers

CIOReview Selects HCIM as 2014’s 20 Most Promising Healthcare Consulting Providers

HCIM honored as one of 2014’s Top 20 Most Promising Healthcare Consulting Providers by CIOReview, for its expertise in delivering technology solutions and consulting services to healthcare payers and managed care organizations HealthCare Information Management, Inc. (HCIM) was selected out of over 400 companies as one of the nation’s 20 Most Promising Healthcare Consulting Providers […]

What do the Midterms Mean for Obamacare?

In the aftermath of the 2014 midterm elections where Republicans gained control of the Senate and maintained control of the House, America is wondering what all this means for the Affordable Care Act. Junior Republican Senator Ted Cruz of Texas had already vowed to dismantle Obamacare once Republicans secured both chambers of Congress, but is […]

HCIM and PCG Software Announce Partnership to Reduce the Cost of Healthcare for Payers and Other Managed Care Organizations

HCIM to Serve as the Exclusive Value-Added Reseller for PCG Software’s Virtual Examiner® and Virtual Reporter® HCIM and PCG Software, Inc. (PCG) today announced an exclusive value-added reseller (VAR) agreement to resell PCG’s Virtual Examiner® and Virtual Reporter® (VE/VR) claims recommendation software to the healthcare payer/managed care industry. With the use of more than 30 […]

HCIM Increases its Product Suite by Signing VAR Agreement with L5 Healthcare Solutions

HCIM is pleased to announce that they have signed a Value-Added Reseller agreement with L5 Healthcare Solutions. HCIM will be reselling L5’s Claims Audit Tool™ to the Health Plan/Managed Care Payer industry. The Claims Audit Tool™ is designed to be used by the audit departments of organizations paying healthcare claims by streamlining the claims audit […]

Citra Health Solutions Selects HCIM as Preferred Partner for EZ-CAP Consulting

Sep. 9, 2014 – JACKSONVILLE, Fla. — Citra Health Solutions (formerly OrangeMZI Healthcare) has selected HealthCare Information Management, Inc. (HCIM) as a Preferred Partner for EZ-CAP® professional consulting services. When Orange Health Solutions and MZI Healthcare merged in April 2014, the newly branded Citra Health Solutions decided to seek out a trusted consulting partner and […]

Heritage Provider Network Secures SymKey® Enterprise License

HCIM is pleased to announce that Heritage Provider Network (HPN) is the first EZ-CAP® client to sign a SymKey® Enterprise license. Their Enterprise level agreement includes access to the entire SymKey® for EZ-CAP® suite of solutions, including the Professional, Hospital, and Virtual Auto-Post™ modules for all seven of HPN’s sites. As an added bonus, HPN […]

New HCIM Customer Portal and Ticketing System

In order to provide our clients with the best possible customer service, HCIM has launched a new ticketing system on the TeamSupport platform. The new HCIM Customer Portal allows clients to submit tickets via a web form, track updates, access support documentation, and search the knowledgebase. When clients submit a ticket via the Customer Portal, […]

Tips & Tricks: SymKey’s “set it and forget it” functionality

SymKey’s enhanced user interface and innovative features including the Query Builder, Query Sequencer, and Scheduler, have greatly improved our clients’ productivity. HCIM’s clients rave about the “set it and forget it” functionality that allows them to run SymKey® unattended. The Query feature allows the building of any type of SQL-language report directly within SymKey®, for […]

Tips & Tricks: Copy and Reverse

Did you know that SymKey® can accurately copy and/or reverse a claim, with or without repricing the contract values in the claim detail lines? Create Exact Claim Copy Functionality Use this action to split claims with a DOS that spans a benefit or contract renewal date, or to divide financial responsibility. With the Exact Claim […]

State of the Payor Industry Survey Indicates Need for Business Process Automation

More than 130 leaders from health plans across the United States responded to HealthEdge’s Jan. 2014 “State of the Payor” industry survey. As a company that offers business process automation solutions, we were particularly interested in question #4 (below), which shows that 81.3% of surveyed payors believe it would significantly reduce their administrative costs to […]

HHS Releases Proposed Rule Regarding Certification of Compliance for Health Plans

January 2, 2014 – The Department of Health and Human Services (HHS) published a proposed rule today regarding certification (also referred to as attestation) under the Affordable Care Act, which is open for comments through March 3, 2014. Certification Requirements The 100-page CMS-0037-P proposed rule would require a controlling health plan (CHP) to submit information […]

HCIM CEO Quoted in Article about the Benefits of ICD-10

HCIM President & CEO, Michael Wilson, was recently interviewed for “The Benefits of ICD-10 to Medical Practices” article written by Shelly K. Schwartz and published in Physicians Practice: For all the doomsday predictions surrounding ICD-10, it’s easy to forget that the complex new coding system slated to go live next year is designed to deliver, […]

ICD-10 is only 365 days away!!!

There’s officially only one year left before the ICD-10 compliance deadline and CMS has no plans to extend the date, so it’s time to get moving! Although the extra year from the ICD-10 extension was intended to give payers and providers time for more testing, many healthcare payer organizations haven’t begun implementing ICD-10 yet. ICD-10 […]

Do you manually apply the 2% Medicare Sequestration?

The Budget Control Act of 2011 required mandatory, across the board reductions in federal spending, which has been more commonly referred to as sequestration. CMS Announces FFS Payment Reductions – March 8, 2013 Due to the sequestration, CMS announced mandatory 2% payment reductions in the Medicare Fee-for-Service (Part A and Part B) Program and would […]

Organize, modify, and auto-load your benefit plans into QNXT™

HCIM’s SymKey® Benefit Plan Loader tool for QNXT™ allows you to update your benefit plan data 6-8x faster! Seamlessly integrates with your QNXT™ claim system and extracts your benefit plans directly into validated spreadsheet templates Stores all your benefit plan data in a centralized location for easy updates Provides accurate and consistent auto-loading of benefit […]

Client Spotlight: Network Medical Management

Network Medical Management (NMM), an MSO overseeing eight IPAs in seven Southern California counties, licensed SymKey 3.0 for EZ-CAP in June 2013. They have been using SymKey to automate their claims processing at speeds averaging over 700 claims per hour. During their 30-day trial, SymKey processed 15,000 claims in 24 hours! “During NMM’s 30-day trial, […]

Can’t find your authorization? Let SymKey do it.

SymKey 3.0 can identify the corresponding Auth IDs for professional claims, automatically populate the authorization, and then reprice all claim lines. As an added bonus, SymKey is able to run unattended around the clock, at speeds averaging over 700 claims per hour. Talk about time savings! And SymKey works within your existing core claims transaction […]

Congratulations to Amy Coon on her 5-Year Anniversary as an HCIM Consultant

We are pleased to congratulate Amy Coon on her 5-year anniversary at HCIM. As a Client Services Professional Consultant, Amy has been engaged on a long term project that’s required her focused attention on delivering timely and accurate solutions. She has thrived in that challenging environment, so much so that our client stated that they would like to engage another HCIM consultant exactly like Amy. Based upon that request, we’re fervently working on developing a cloning machine.

CMS Releases 2014 ICD-10-PCS Guidelines, Code Tables and Index

On May 17, 2013, CMS released the 2014 ICD-10-PCS Materials, including guidelines, code tables, index, what’s new, a quick reference guide, and more. On October 1, 2014, ICD-10-PCS will replace ICD-9-CM, Volume 3, for coding inpatient procedures. Of course, CPT codes will still be used for outpatient procedures and services.

CMS also clarified that there will be no national requirement for the reporting of ICD-10-CM codes in Chapter 20, External Causes of Morbidity, although providers are encouraged to voluntarily report external cause codes. However, as with ICD-9-CM, providers may still be required to report ICD-10-CM external cause codes by their state or payer(s).

Kimberly Magras Celebrates Five Years with HCIM

Five years ago today, Kim Magras joined HCIM as an Executive Assistant and worked her way up to Administrative Services Coordinator three years later. She now oversees the company’s administrative services, including human resources, payroll, benefits, Colleague onboarding and training, policies and procedures administration, event coordination, vendor management, and managing HCIM’s Colleague Resource Center. “Kim […]

EZ-CAP Clients Process 749 Claims per Hour with SymKey Automation

The 2012 SymKey® for EZ-CAP® Productivity Stats are in and five of our clients are averaging over 1,000 claims per hour (CPH)! Overall, HCIM’s SymKey for EZ-CAP clients averaged 749 claims per hour last year. Now that’s smoking fast! Take a look at the 2012 SymKey for EZ-CAP productivity stats below. Highlighted Stats Overall Averaged 2012 SymKey […]

5 SymKey Clients Exceed 1,000 CPH in 2012!

The 2012 SymKey for EZ-CAP productivity stats are in and five of our clients are averaging over 1,000 claims per hour (CPH)! The average claims processing speed is 749 claims per hour and one of our clients is processing an unprecedented 3,000+ claims per hour. HCIM’s SymKey for EZ-CAP application is specifically designed to automate […]