Category: Revenue Cycle Management

Prior Authorization in Medicare Advantage : Lawmakers Call for Streamlined Process

CMS has proposed a rule to simplify prior authorization in government-sponsored health insurance programs. However, some lawmakers are urging the agency to do more. A bipartisan coalition of 233 representatives and 61 senators have written a letter to CMS requesting that the proposed rules be expanded and that the changes be finalized quickly to enhance […]
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The High Costs of Delaying AI Adoption in Revenue Cycle Management

The prominent role of AI in healthcare is hard to ignore. In recent years, significant advancements have been witnessed in the field of revenue cycle management (RCM), particularly in coding and billing. The emergence of new technologies incorporating natural language processing, deep learning, and other cutting-edge techniques has revolutionized the process, surpassing the limitations of […]
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Denial Management and Strategies to Reduce Claim Denials

Denial Management and Strategies to Reduce Claim Denials

Denial management is a critical process in the healthcare industry that involves identifying, analyzing, and resolving claim denials. Claim denials occur when healthcare providers’ reimbursement requests are rejected by insurance companies due to various reasons. These denials can have a significant impact on providers’ revenue and overall financial health. In this blog post, we will […]
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The Impact and Challenges of Medicare Advantage for Payers and Providers

The Impact and Challenges of Medicare Advantage for Payers and Providers

Medicare Advantage (MA) is becoming more appealing to payers due to its numerous benefits, but providers are struggling to adjust to its effects. Payers are increasingly recognizing the advantages of MA, especially in terms of profitability. According to a study conducted by the Kaiser Family Foundation (KFF), MA insurers disclosed an average gross margin of […]
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Strategies for Maximizing Revenue Cycle for Financial Success

Strategies for Maximizing Revenue Cycle for Financial Success

Based on a recent survey conducted by MGMA, it was found that 40 percent of medical practices were unsuccessful in attaining their revenue objectives in 2021. The survey participants emphasized various significant obstacles, including insufficient staffing, escalating expenses, and delayed payments from payers. To tackle this widespread revenue shortfall, healthcare providers are urged to prioritize […]
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Key to RCM Success: Expertise in Denial Management, Coding & Prior Authorization

Key to RCM Success: Expertise in Denial Management, Coding & Prior Authorization

A survey conducted by leading healthcare technology company, revealed the top revenue cycle tasks like denials management, coding, and prior authorizations requiring the most subject matter expertise. Out of 15 tasks listed, over 550 healthcares financial and revenue cycle leaders identified denials management, coding, and prior authorizations as the top choices. Denials management was chosen […]
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Preventing Denial with the Power of Critical Thinking Skills

Preventing Denial with the Power of Critical Thinking Skills

Lately, I’ve been thinking about how to prevent claim denials, especially considering the high number of claims that were denied in 2021. As coders, we can use critical thinking skills to improve the accuracy of our coding and ultimately reduce claim denials. Critical thinking involves formulating questions, gathering information, applying the information, considering the implications, […]
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