Claims Denial: Healthcare Leaders report an increase in payer denials, putting increasing pressure on the system’s finances. Going back and forth with denied payers is a long and expensive process, and low reimbursement rates don’t help either. In a new survey conducted by the Healthcare Financial Management Association, CFOs noted a significant increase in denials, […]
In today’s healthcare environment, optimizing revenue cycle management (RCM) is no longer a luxury. It is necessary rising costs, complex regulations and rising patient deductibles are forcing healthcare organizations to spend every penny they can. Fortunately, you can use some effective strategies to streamline your RCM process, reduce errors, and increase profitability. Understanding currency conversion: […]
In the intricate realm of healthcare revenue cycle management (RCM), the substantial challenge revolves around handling denied claims. Scarcity of resources, understaffing, and restricted capacity frequently lead to difficulties in resolving denied claims, where an alarming 82% to 90% are considered potentially preventable. RCM teams can optimize time and revenue recovery by employing proactive strategies […]
Claims management serves as a valuable tool for insurance firms, enabling them to identify the root causes of claim errors, measure areas for improvement, and explore new opportunities to continuously enhance their operations. However, the ever-increasing complexity of claims administration poses a formidable challenge for insurance businesses, hindering their ability to uncover fresh prospects and […]
CMS has expanded the prior authorization requirement to two new service categories within hospital outpatient department services. The Centers for Medicare & Medicaid Services (CMS) has expanded the prior authorization requirement for two additional hospital outpatient department (OPD) services. Effective with date of service July 1, 2021, CMS has expanded the prior authorization requirement to […]
Improving clinical documentation quality, leveraging technology, and educating providers are key ways hospitals improve medical coding compliance in a value-based world. Medical coders are typically behind the scenes of patient care, analyzing records, selecting codes for billing, and managing patient data. But to a revenue cycle expert with over 20 years of coding experience at […]
Medicare Advantage Plan contracts are “take-it-or-leave-it” agreements Many questions are swirling about regarding Medicare Advantage Plan (MAP) denials asking what to do about the increasing number and given reasons. I’ve heard or read some amazing stories where payers have gone to astounding lengths to deny claims. Answers are also swirling about based on understandings of […]
By now, these medical payment denial statistics are old news: • 50-65% of denied claims are never reworked • 200 million claims are rejected every year • 90% of denials are avoidable Although these numbers are common and, most likely, first-hand knowledge among providers, they continue to frustrate medical practices year after year. That’s why […]
Merging front and backend functions, leveraging data, collecting payments upfront, and automating prior authorizations are key to healthcare revenue cycle management excellence. “There is always room for improvement” should be healthcare revenue cycle management’s mantra. Declining claims reimbursement rates, the shift to value-based purchasing, and evolving health policies keep revenue cycle leaders constantly seeking new […]
Even as recently as five years ago, the revenue cycle outsourcing process took on a very different form to that of today. For years, most organizations saw the revenue cycle as little more than a cost center – meaning that revenue cycle outsourcing was a decision made largely from an administrative perspective. It was seen […]