Tag: healthcare payers

Automating Claim Processing

Automating Claims Processing in the Healthcare Industry

By utilizing automation, it is feasible to improve the upstream and downstream adjudication process through data validation and routing. The healthcare industry can benefit from automation in almost all administrative functions, but it can significantly improve the auto-adjudication rate. In an ever-changing industry, possessing technical expertise is of utmost importance. The healthcare sector is increasingly […]
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The-State-of-Claims-and-Denials-in-2023

The State of Claims and Denials in 2023

How do you resolve a repeated and shooting up problem like claims denials? It’s been a fresher subject for revenue cycle management professionals for years that are only experiencing hotter with the growing pressures of staffing shortages, troubles with staff movement and instructing and developing policies and protocols at the government and payer levels. On […]
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Key-Benefits-of-Using-Total-Practice-Management-System

Key Benefits of Using Total Practice Management System

Providers draw more on-time and uncut payer reimbursements and patient payments by automating these operations with a quality practice management system Via using a quality total practice management system, your company can evade putting as much attempts into accomplishing quality work and rather find effectiveness, accuracy, and peace of mind. An integrated billing and scheduling […]
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Hospitals-Comply-with-the-Price-Transparency-Rule

Only a Few Hospitals Comply with the Price Transparency Rule

Over 1,500 hospitals reviewed in the report were noncompliant with at least one requirement of the price transparency rule between December 2022 and January 2023. Less than a quarter of hospitals are complying with the hospital price transparency rule over two years after the regulation went into effect, according to a report from PatientRightsAdvocate.org. The […]
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Increased-Data-Transparency-Results-Higher-Compliance

Increased Data Transparency Results In Higher Compliance

One Medicare Advantage plan used the Ribbon tool to focus on quality measures and saw a 342% net increase in users achieving a 4+ star rating. Increased data transparency between health plans and providers on care and coding gaps results in higher compliance, process improvement and positive behavior changes among network providers, according to a […]
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Medicaid-Expansion-Boosts-Financial-Performance-of-Providers

Medicaid Expansion Boosts Financial Performance of Providers

Medicaid expansion improved financial performance for healthcare providers and was associated with lower uncompensated care costs and higher revenues. Medicaid expansion has positively impacted healthcare providers by boosting financial performance and resulting in payer mix improvements, data from the Kaiser Family Foundation (KFF) found. All but 11 states have expanded Medicaid eligibility as of January […]
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2023-Big-Year-For-Denials-Management

2023 is set to be a Big Year for Denials Management

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 […]
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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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Medical-Coding-Audits-Trends-and-Guide

Medical Coding Audits: Trends and Guide for Physicians

You’ve received a request for medical records from a payer, who is going to conduct an audit on your claims. Your Electronic Health Record (EHR) system is excellent, the notes are voluminous, your providers are well-versed at coding. If anything, you under code! You provide excellent care for your patients and achieve great outcomes. No […]
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Payers-Wrongly-Cutting-Payments-To-Physicians-For-EM-Services

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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