Category: Blog

AI in RCM: Overcoming Challenges and Enhancing Efficiency

AI in RCM: Overcoming Challenges and Enhancing Efficiency

In response, many providers are turning to AI in RCM to alleviate these pressures, leveraging automation to streamline claims processing, improve documentation accuracy, and reduce denials.” This integrates the keyword smoothly while keeping the focus on the challenges faced by healthcare providers and how AI in RCM can help address them. Healthcare providers are facing […]
Learn More
Denial Prevention: A Strategic Imperative for Revenue Cycle Management

Denial Prevention: A Strategic Imperative for Revenue Cycle Management

Denial prevention has become a paramount focus within healthcare revenue cycles, as the financial toll of claim denials continues to rise. The increasing use of artificial intelligence (AI) by payers has further exacerbated this challenge. To mitigate these losses, a strategic shift is necessary, transitioning from a reactive approach of managing denials post-occurrence to a […]
Learn More
How to Fight Surprise Medical Bills and Coverage Denials: A Proven Strategy

How to Fight Surprise Medical Bills and Coverage Denials: A Proven Strategy

Have you recently received a surprising medical bill or had your insurance coverage denials for a recommended treatment? Unfortunately, you’re not alone. A recent national survey by the Commonwealth Fund, a leading healthcare research organization, found that a significant number of insured Americans face these challenges. While many may choose not to contest these issues, […]
Learn More
October 2024 HCPCS Level II Code Updates

October 2024 HCPCS Level II Code Updates

Discover the October HCPCS Level II Code Set Update: October 2024 HCPCS Level II code set will receive a quarterly update, introducing 32 new drug and biological codes. Additionally, five codes will be deleted, and five others will undergo revisions. Let’s explore what’s in store. New HCPCS Level II Codes The Centers for Medicare & […]
Learn More
Medicare Advantage Reform: Rising Scrutiny and Political Shifts

Medicare Advantage Reform: Rising Scrutiny and Political Shifts

Medicare Advantage (MA) plans, a type of private health insurance that serves as an alternative to traditional Medicare, have long been a subject of debate within the healthcare industry and among policymakers. However, recent political developments suggest a growing appetite for MA reform, marking a significant departure from previous bipartisan consensus. A Rising Tide of […]
Learn More
Navigating the Financial Impact of Value-Based Care (VBC)

Navigating the Financial Impact of Value-Based Care (VBC)

The financial impact of VBC is profound, necessitating adjustments in how providers approach and manage their financial operations to align with this new model of care. The healthcare industry is shifting towards value-based care (VBC), a model that prioritizes high-quality care while aiming to lower costs. In contrast to the traditional fee-for-service model, value-based care […]
Learn More

Medicare Prescription Drug Benefit Premiums Spike Amid Inflation Reduction Act Changes

Inflation Reduction Act: A Double-Edged Sword for Medicare Beneficiaries: The Biden administration’s recent announcement of the first Medicare drug price cuts, mandated by the 2022 Inflation Reduction Act, has dominated headlines. However, another significant impact of this law—substantial premium hikes for some Medicare beneficiaries—has largely been overlooked. The Inflation Reduction Act represents the most sweeping […]
Learn More
Overcoming CDI and Coding Challenges: The Power of AI-Driven Solutions

Overcoming CDI and Coding Challenges: The Power of AI-Driven Solutions

Defining the Challenge: Overcoming Obstacles in CDI and Coding: To clarify the overwhelming claims made by technology vendors, I’ve provided some basic definitions. As we embark on this journey, it’s crucial to pinpoint the specific obstacles we face. This will help us demonstrate to senior leadership and stakeholders the need for AI-driven solutions to enhance […]
Learn More

Medicare Advantage Prior Authorization Denials on the Rise

Surge in MA Prior Authorization Denials: New Study Reveals A new study highlights significant variation among Medicare Advantage plans regarding the number of determinations made and the frequency of denials. Notably, MA Prior Authorization Denials surged between 2021 and 2022, according to a recent analysis from health policy research. Researchers examined data from the Centers […]
Learn More
Value-Based Care: Navigating Challenges and Opportunities in Revenue Cycle Management

Value-Based Care: Navigating Challenges and Opportunities in Revenue Cycle Management

RCM and Value-Based Care Challenges and Opportunities: Healthcare is a dynamic field constantly evolving to improve patient and staff experiences. As the industry transforms, it’s crucial to understand both the potential benefits and drawbacks of these changes. One area experiencing significant evolution is Revenue Cycle Management (RCM). The shift towards value-based care models is a […]
Learn More
x
Close