Latest Articles, News & Updates

Optimizing Payer Contract Rates with Open Care Data
Discussing how to use the data provided by Open Care Data to negotiate payer contract rates.
Raichelle Stanturf on Thursday, January 18, 2024
Healthcare ghost rates in insurance contracts reduce the QPA for your area
Ghost Rates and Shadow Rates impact the calculation of Qualifying Payment Amounts (QPA) by reducing the in-network median rate in your area.
Brandon Griffin on Tuesday, August 29, 2023
Using OpenCare Data and GoRev to dynamically generate No Surprise Act appeal of QPA
Users of the GoRev software can now access OpenCare Data statistic rates within the system itself. This can be used to dynamically create insurance appeals of underpaid QPA (qualifying payment amount).
Brandon Griffin on Wednesday, August 16, 2023
Open Care Data - How To Get Started Tutorial.
Unlock your full potential with our tutorial designed to guide you through every step. From beginner to advanced, our tutorial covers it all. Watch now and embark on a journey of knowledge and mastery. Start learning today!"
Brandon Griffin on May 23, 2023

More Articles

Unraveling the Complex Dynamics of Healthcare Claims Appeals: Navigating Power Struggles, Shadow Rates, and Equitable Solutions Unveiling Healthcare's Hidden Power Struggle: Payers, Providers, and Shadow Rates. Let's explore the gripping clash reshaping reimbursement, policy, and data transparency, and discover how tools like OpenCareData are illuminating the path forward.
Addressing Healthcare Consolidation: The Impact of Physician Practice Acquisitions on Medicare Payments Let's explore the growing trend of hospitals and corporations acquiring physician practices and the effects that it is having on Medicare payments and patient care. Additionally, we need to take a clear look at the disparity in payment rates for procedures performed in hospital-affiliated facilities versus independent offices. Lastly, let's be optimistic about the broad bipartisan support around a site-neutral payment system as a solution to promote fair reimbursement and transparency.
Behind the Scenes: The Struggle of Healthcare Providers Under the CMS's Interpretation of the 'No Surprises Act' CMS's recent interpretation of the 'No Surprises Act' puts undue burden on healthcare providers while benefiting insurance companies. Using data from recent health insurance premium reports, the article highlights the growing financial pressure on healthcare workers and calls for a balanced system that prioritizes patient-centric care over financial gain. It emphasizes the need to support the professionals at the heart of our healthcare system for the wellbeing of our nation.
Challenges in Emergency Department Medicine Let's explores the current challenges faced by emergency department (ED) medicine amidst ongoing healthcare changes. The aftershock of the COVID-19 pandemic, Medicare reimbursement cuts, and evolving billing requirements have created a demanding environment for emergency providers. From staffing shortages and financial strains to changes in patient behavior, this article sheds light on the hurdles EDs must overcome to continue delivering quality care to patients in need.
CMS Proposed Rule Sparks Concerns Over Reimbursement Cuts for Emergency Medicine There are pressing issues surrounding proposed reimbursement cuts to emergency medicine by the Centers for Medicare and Medicaid Services (CMS). This blog highlights the strong objections raised by the Emergency Department Practice Management Association (EDPMA) and emphasizes the potential impact on patient care and the financial stability of emergency medicine practices.
Senators Call for Strengthened Price Transparency in Health Insurance: Leveraging OpenCareData for Enhanced Insights on the Path to Transparency Independence In this blog, we delve into the efforts of Senators Maggie Hassan and Mike Braun, who are leading the charge for enhanced price transparency in health insurance. As Independence Day is upon us, they call on the Centers for Medicare and Medicaid Services (CMS) to address technical loopholes that hinder effective implementation of the Transparency in Coverage rule. Discover how leveraging OpenCareData's robust data capabilities can provide policymakers, researchers, and employers with enhanced insights, enabling them to uncover unreasonable costs and foster a transparent and affordable healthcare system.
Understanding the AI Bill of Right In October 2022, the White House introduced the "Blueprint for an AI Bill of Rights." This document outlines important principles and guidelines related to the ethical and responsible use of artificial intelligence. In this blog post, I will summarize the key points of the AI Bill of Rights, providing a condensed version that is easier to understand and digest. Consider it your AI Bill of Rights Cliff Notes.
Enhancing Medical Billing: The 'Health Care Billing' Act and Qualified Payment Amounts (QPA) Empowering Patients and Providers Discover how the 'Health Care Billing' Act and Qualified Payment Amounts (QPA) are transforming medical billing practices in Texas. Explore the enhanced transparency, cost awareness, and efficient dispute resolution these measures bring, empowering patients and providers alike. Uncover how these changes are revolutionizing the healthcare landscape and promoting fairness in medical billing.
Achieving Comprehensive Healthcare Cost Transparency: Leveraging Transparency in Coverage, OpenCareData, Fair Health Due to the Transparency in Coverage rule, resources such as OpenCareData and Fair Health revolutionize healthcare cost transparency. Discover how negotiated rates, localized cost estimates, and market research insights from these data sources empower patients, providers, and payers to make well-informed decisions. With fair negotiations, appeals support, and strengthened legal arguments, pave the way for a transparent healthcare system that ensures equitable decision-making and benefits everyone.
The No Surprises Act (NSA) Implementation: A Struggle for Balance and Fairness Let's explore the difficulties and consequences faced during the implementation of the No Surprises Act (NSA), including controversies surrounding independent dispute resolution and the Qualifying Payment Amount, and how these challenges affect healthcare providers and patient care.
Navigating Claim Denials and Appeals: Unveiling Transparency Gaps and Challenges Let's explores the challenges consumers face with claim denials and appeals in ACA marketplace plans. This article emphasizes the need for transparency, highlights the wide variations in denial rates, and underscores the limited success of appeals, ultimately advocating for improved oversight and informed decision-making for consumers.
Mastering Qualifying Payment Analysis: Strategies for Accuracy and Compliance Let's discuss the challenges of calculating Qualifying Payments in healthcare reimbursement and provides actionable strategies to enhance accuracy and compliance. By emphasizing the importance of staying updated on reimbursement policies, leveraging technology, fostering a culture of continuous learning, etc. we can improve payment analysis accuracy.
The No Surprises Act: Potential Changes under Republican and Democrat Control of Congress What NSA changes are possible in a Republican Vs Democrat controlled congress?