Tag: Claims Management

Claims Reimbursement Speed and Denial Rate

The Impact of Location on Claims Reimbursement Speed and Denial Rate

A recent examination has revealed a significant link between the operational location of healthcare providers and the speed and accuracy of claims reimbursement by insurers. If your practice encounters delays in claims reimbursement, this may be attributed to the geographical area in which your practice is situated, according to a recent scrutiny of financial transactions. […]
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How to Improve the Front-End Revenue Cycle and Get Paid Faster

Numerous pre-claims management factors significantly influence the revenue cycle, underscoring the critical importance of optimizing front-end processes for a healthcare provider’s financial prosperity. The healthcare revenue cycle comprises three distinct phases: the front-end, mid-cycle, and back-end. While significant attention is often given to mid and back-end functions, such as coding and billing, claims management, and […]
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Top Advantages of Automated Medical Claim Processing

With the arise of indirect health practices such as telehealth, it is becoming increasingly indispensable to play with bill payments and claims orderly. The medical billing cycle is a complex system encompassing procedures such as medical recordkeeping and patient data processing. Medical claim processing is the keystone for healthcare insurance companies since it needs data […]
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Automating Claims Management Processes May Reduce Costs

The adoption of electronic transactions increased in 2021, but further automation of claims management processes could save healthcare providers nearly $25 billion annually. Automating claims management processes could help healthcare providers curb the high spending on administrative transactions they saw in 2021, according to the 2022 Index report from the Council for Affordable Quality Healthcare, […]
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EHR-RCM Integration Can Improve Revenue Cycle Efficiency

Partnering with a vendor that provides EHR and RCM capabilities helped one healthcare organization boost communication and improve revenue cycle efficiency for 150 care centers. Leveraging automation for revenue cycle management (RCM) processes can streamline tasks and improve efficiencies. Specifically, partnering with an EHR vendor helped a healthcare organization to achieve $1 billion in patient […]
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Three KPIs that Create an Impact on Your Revenue

In 30 years of running revenue management the usual suspects come up in a Key Performance Indicator (KPI) Dashboard such as Charges, Payments, Adjustments, Net Collection, Gross Collection, Days in AR, AR over 90 Days and Bad Debt. Then you have the breakouts for each category by payer, CPT Code, Location, or ICD Code. There […]
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Payers Wrongly Cutting Payments To Physicians For E/M Services

Payers have been wrongly cutting payments to physicians for evaluation-and-management (E/M) services—often automatically through the use of claim-editing algorithms. A new AMA resource helps physicians fight back against health insurer downcoding. Downcoding happens when a payer changes a claim to a lower-cost service than what was submitted by the physician, leading the practice to get […]
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Claim Denial Rates as High as 80% for In-Network Services

A new analysis shows that claim denial rates for in-network services among Healthcare.gov marketplace payers varied significantly, with some as high as 80%. Claim denial rates varied significantly among Healthcare.gov marketplace payers, with some insurers racking up rates as high as 80 percent, according to a new analysis from Kaiser Family Foundation. Marketplace payers must […]
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How to avoid medical necessity denials

How to avoid medical necessity denials and ensure timely payment. Sick visit on the same day as an annual wellness visit (AWV) Reason for denial: Lack of clear clinical documentation regarding why the physician had to go above and beyond what is normally addressed during an AWV. How to avoid it:“I often tell doctors to […]
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