A recent survey highlighted how payment cuts are affecting denial strategies. Healthcare organizations are on the verge of stepping up their denials management strategies in 2023 as rate cuts are expected to impact revenue. On the delivery side, most practices plan to continue their telehealth operations in the New Year, according to the 2023 Part […]
The billing and collection process in medical offices can be a time-consuming and error-prone process. This can lead to denied claims, uncollected revenue, and frustrated patients. Medical billing companies are looking for ways to optimize this process to improve efficiency, accuracy, and patient satisfaction. One way to optimize the billing and collection process is to […]
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 […]
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 […]
More than 80% of leading health systems that are using RPA/AI say their primary reason for investing in the technology was improving financial performance, but once the technology was in use, they said efficiency was the top benefit. The reasons that leading health systems initially invest in robotic process automation (RPA) and artificial intelligence (AI) […]
HHS reduced the Medicare appeals backlog by 79 percent during the third quarter of FY 2021, putting the department ahead of schedule to clear the backlog. As of June 30, 2021, the end of the third quarter of FY 2021, HHS had 86,063 pending appeals remaining at the Office of Medicare Hearing and Appeals (OMHA), […]
Average claim denial rates are between 6% and 13%, but some hospitals are nearing a “danger zone” after COVID-19, a survey shows. Hospital claim denial rates are at an all-time high, signaling a need for better claims denial management, a recent survey from Harmony Healthcare reveals. The healthcare industry has seen a 20 percent increase […]
Days in accounts receivable (A/R) is one of the most important key performance indicators for growing practices. In an increasingly complex healthcare environment—and one in which financial responsibility is shifting to the patient—keeping track of how long it takes to collect healthcare revenue that a practice has billed but has yet to receive from payers and […]
Typical CDI programs are intended to drive reimbursement through diagnosis securement, contributing to improved case mix index. The COVID-19 pandemic is placing monumental financial stressors upon hospitals, with added costs to treat patients with high acuity and long length of stays, coupled with significant revenue loss associated with postponement of more profitable elective surgeries, like […]
If there’s one thing healthcare providers can agree on, it’s that prior authorization management is a heavy administrative burden and only growing heavier. Decades ago, it was created to ensure care standards continuity, improve safety and regulate costs but has become an unwieldy process filled with manual tasks and roadblocks that dilute the original intent. […]