Tag: Healthcare Claims


8 Successful Tactics for Reducing Denied Claims 2024

Roughly 65% of rejected claims aren’t reprocessed for resubmission (Zindl, 2021). As one of the healthcare industry’s numerous challenges, the upward trend of denied claims persists, with many left unaddressed. This has repercussions for both providers and patients alike. When denied claims remain unsubmitted, providers face substantial losses. Beyond revenue, these rejections strain staffing resources. […]
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Unnoticed Medical Billing Changes in 2023

While not every policy alteration by the Centers for Medicare & Medicaid Services (CMS) grabs headlines, it’s often these less-publicized changes that lead to the most billing complications. Here are a couple of recent adjustments made by CMS that you might have overlooked. New Place of Service Code CMS introduced a new Place of Service […]
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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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A Surgeon General Touts Possible Changes in Prior Authorizations

Federal healthcare leaders say they are committed to helping physicians, patients, and health insurance companies by improving the prior authorization process for medical care. On Jan. 17, Center for Medicare & Medicaid Services Administrator and U.S. Surgeon General Vice Admiral, held a listening session with health care stakeholders. That was followed by a conference call […]
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Health Care Industry Will Face Myriad Challenges in 2023

Health care leaders are anticipating a turbulent 2023, according to a report. Staffing, inflation, shrinking margins, and supply chain issues are among the top concerns that will continue to challenge hospitals and health systems and have an outsized effect on overall strategy. Here are the four factors identified as being the most likely to impact […]
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Introduction to the WHO’s ICD-11

Cluster coding is a new feature for coding professionals. The World Health Organization (WHO) began developing the International Classification of Diseases, Eleventh Version (ICD-11), in 2007, and first released a preliminary version for evaluation and testing in 2016 – ironically, just one year after the U.S. finally adopted a clinical modification of the WHO’s ICD-10 […]
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What are the Costs and Benefits of Medicare Audits?

For most readers the results of this analysis will be amazing but true. Longtime RACmonitor contributor and R1 Physician Advisory Services Vice President Dr. Ronald Hirsch recently pointed site Publisher Chuck Buck in the direction of something that, frankly, wowed him: a PhD thesis from a young Columbia University student on the topic of the […]
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Claims Payment Transformation Benefits Payer, Providers, and Members

Payers, providers, and members can all benefit from transforming the manual and patchwork claims payment process to a digital environment that also automates claims data delivery. Payers, providers, and members are all central to the healthcare experience, working together to create a seamless, coordinated encounter from registration and the clinical visit to claims payment and […]
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Optum partners with SSM Health and will employ certain revenue cycle staff

To reduce care variation, SSM and Optum will use clinical technologies, advanced analytic and data-driven insights at the point of care. Certain SSM Health revenue cycle staff and hospital care management will become employees of Optum. They will continue to work in their current locations across Illinois, Missouri, Oklahoma and Wisconsin. WHY THIS MATTERS As […]
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