Tag: Healthcare Administration

Insurance Claim Denials

Navigating Insurance Claim Denials: A Step-by-Step Guide

Imagine receiving an Insurance Claim Denials notice that states services are not covered or require prior authorization. Table of Contents Requires Prior Authorization Coverage Terminated or Member Not Eligible on the Date of Service Services Performed are Non-Covered Maximum Benefit for This Service Has Been Met Steps for Obtaining Authorization The Importance of Verification and […]
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Healthcare payment integrity

How AI and Automation are Revolutionizing Payment Integrity in Healthcare

Healthcare payment integrity is a crucial aspect of efficient claims processing, and its improvement can significantly reduce costs and improve patient care. Healthcare costs continue to climb, burdening patients, providers, and insurers alike. A significant driver of this issue is the inefficiency of healthcare administration, particularly in claims processing. Despite standardized claim formats, outdated systems […]
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HIPAA violations

How to prevent HIPAA violations in healthcare

HIPAA violations happen when a healthcare organization fails to follow the Health Insurance Portability and Accountability Act (HIPAA) rules. HIPAA is a law that protects patients’ privacy by setting standards for securing and sharing their medical information. There are different ways a HIPAA violation can occur, but they often involve a patient’s protected health information […]
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Physicians-face-dual-burden-between-patient-care-and-medical-coding

Clinicians Struggle with Medical Coding Amid Patient Care Responsibilities

Presently, healthcare professionals face growing administrative demands alongside their patient-focused duties. A pivotal challenge among these is medical coding, essential for various reasons. It ensures adherence to billing standards impacting reimbursements, meets quality metrics established by healthcare entities and insurers, and guarantees precision in diagnoses recorded for billing purposes. Yet, the task of accurate coding […]
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Benefits of Advanced Healthcare Technology

Benefits of Advanced Healthcare Technology for Providers & Payers

Collaboration among a diverse team that blends clinical expertise and technical proficiency is essential in today’s dynamic healthcare environment to overcome administrative and diagnostic challenges. This multidisciplinary approach facilitates the creation of healthcare technology solutions that benefit all stakeholders, including payers, providers, and patients. By adopting a more personalized approach, treatment outcomes can be optimized […]
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Surprise Medical Billing

President’s Efforts to Limit Surprise Medical Bills and Reduce Health Care Expenses

The President administration has announced its intention to restrict the sale of “junk” insurance policies, including short-term plans that may not provide adequate coverage for individuals who are in-between jobs and require temporary health care coverage. These policies have been known to deny basic coverage to policyholders. On Friday, President announced a set of fresh […]
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Impact of Technology on Healthcare Management

The Impact of Technology on Healthcare Management

To efficiently manage healthcare, it is imperative for systems and management teams to maintain a continuous focus on becoming leaner. Healthcare administrators are responsible for overseeing an increasing number of hospitals, clinics, and medical facilities. Their responsibilities include managing operations, facilities, accounting, and policy, as well as evaluating and recommending new technology to improve patient-centered […]
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Administrative-Challenges-Medical-Practices-2023

Administrative Challenges for Medical Practices in 2023

The number of prior authorization requests continues to increase — despite promises to the contrary by payers — costing physicians time and money. A Medical Group Management Association (MGMA) poll found that 70% of medical groups indicated that prior authorizations increased in the last year. Physicians say that their practices continue to struggle with either […]
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Top-Challenges-for-Care-Management-Coding-in-2023

Top Challenges for Care Management Coding in 2023

Providing care management services, including chronic care management (CCM) and principal care management (PCM), is not easy. The first overarching challenge is that not enough patients actually participate in care management with a primary care physician. In fact, A recent report from the Primary Care Collaborative and the American Academy of Family Physicians’ more Americans […]
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