Category: Blog

Unlocking the Secrets of Denied Claims: Insights, Solutions, and Strategies

The Prime Minister’s recent voluntary national survey shed light on the Denied claims. The survey, conducted between October and December 2023, found that nearly 15% of all Medicare Advantage, Medicaid, Commercial and Managed Medicaid claims were denied. Between 45% and 60% of rejected cases were overturned, although the expensive appeals process sometimes meant multiple appeals. […]
Learn More

Proposed Rule for inpatient and LTCHs for FY 2025

2025 CMS Proposed Rule: Announcing this week a proposed rule for inpatient and long-term care hospitals (LTCHs) for the fiscal year of 2025 (FY), federal officials cited an increasing focus on social determinants of health (SDoH). The Centers for Medicare & Medicaid Services (CMS) also prioritized improving maternal health and strengthening emergency preparedness, which noted […]
Learn More
Prior Authorization Reform: AMA’s Impact on Doctors, Patients

Prior Authorization Reform: AMA’s Impact on Doctors, Patients

 Prior Authorization Reform, a lengthy and often frustrating process for payers to control costs, remains a major challenge for doctors. A recent AMA survey of 1,001 physicians found that 89% of physicians believe prior licensure hurts clinical practice. A surprising 33% said the worst things, such as death or hospitalization, were rights-related.  The AMA recognized […]
Learn More
CMS Updates Hospice, Palliative Care Regulations for 2025

CMS Updates Hospice, Palliative Care Regulations for 2025

It’s April, and that means it’s time for proposed rules for fiscal year 2025  to emerge. But the Centers for Medicare and Medicaid Services (CMS) prevailed this year, releasing proposed rules for inpatient rehabilitation, psychiatric patients, hospitals, and skilled nursing facilities (SNFs) in late March. I thought a suggestion was worth mentioning. Additional Benefits for […]
Learn More
Specialty care improves outcomes and reduces costs for CMS

Specialty care improves outcomes and reduces costs for CMS

Streamlining Specialty Care: CMS’s Innovation Center prioritizes strategies that improve personalized healthcare information, implement financial services, and support segment-based classifications. A value-based approach to care must address underlying issues and individualized care to reduce patient outcomes. CMS’s innovation strategy describes ongoing efforts to integrate personalized care into the healthcare system. Previous studies have shown that […]
Learn More
Optimize Your Practice with Expert Chiropractic Billing Services

Optimize Your Practice with Expert Chiropractic Billing Services

Choosing the Right Chiropractic Billing Company The efficient billing practices are crucial for the success of any chiropractic practice. Managing insurance claims, patient payments, and other financial aspects can be time-consuming and complex. That’s where chiropractic billing services come into play. By outsourcing these tasks to experts, chiropractors can focus on providing quality patient care […]
Learn More

CMS released the CMS Interoperability and Prior Authorization final rule

CMS Interoperability and Prior Authorization Final Rule: On January 17, 2024, the Centers for Medicare and Medicaid Services (CMS) published the CMS Interoperability and Prior Authorization final rule (CMS-0057-F). The final rule aims to reduce the burden on patients, providers, and payers by consolidating the authorization process and moving the industry electronically. Affected payers must […]
Learn More
How Prior Authorization Transformation Benefits Patients, Providers and  Payers

How Prior Authorization Transformation Benefits Patients, Providers and  Payers

Prior authorization transformation of consent is a source of worry and concern for everyone involved: patients, members, providers, and payers. What was needed was a structure to coordinate all stakeholders and organize the program. In January 2024, the Centers for Medicare and Medicaid Services (CMS) finalized requirements to expedite the authorization process; this requirement will […]
Learn More
Stop Authorization Denials in Tracks

Stop Authorization Denials in Tracks

Getting bogged down by authorization denials? You’re not alone. Here, we explore common roadblocks and effective strategies to keep your revenue flowing smoothly. Challenge: Drowning in Last-Minute Authorizations Solution: Divide and Conquer with a Multi-Team Approach Separate teams can tackle present and future authorizations. The “Today” team verifies benefits and identifies authorization needs for upcoming […]
Learn More
x