Tag: Healthcare providers

No Surprise Act - Court Judgement

No Surprises Act Final Rule Favors Insurers, Must Be Revamped

In a win for physicians, a federal court for the second time in less than two years has rejected the government’s attempt to implement an independent-dispute resolution process that Congress created with the 2020 “No Surprises Act.” The Texas Medical Association (TMA) and others challenged the final rule, showing how language in it still favored […]
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Prevent Denial Readmission

Six Steps to Prevent Readmission Denials

Prevention of readmission denials improves case mix index (CMI), reimbursement, and quality metrics. As a consultant, I am like the FBI – if you invite me in, I will likely take your case. This often leads to varied and challenging projects. Often, I am engaged to assess opportunity in provider documentation, clinical documentation integrity (CDI) […]
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Automating-Claims-Management-Processes-May-Reduce-Costs

Automating Claims Management Processes May Reduce Costs

The adoption of electronic transactions increased in 2021, but further automation of claims management processes could save healthcare providers nearly $25 billion annually. Automating claims management processes could help healthcare providers curb the high spending on administrative transactions they saw in 2021, according to the 2022 Index report from the Council for Affordable Quality Healthcare, […]
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How-To-Improve-And-Make-EHR-More-End-User-Friendly

How To Improve The EHR And Make It More End-User-Friendly

Erica Remer, MD, CCDS, a Member Board of Directors of American College of Physician Advisors, have been talking about improving the electronic medical record and making it more end-user-friendly. Today, she grouses about documentation in general. Her husband, who is a radiologist, and she were commiserating at how awful and uninformative provider documentation has become […]
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Cost-Of-Denials-Saw-Increase-In-2022

Cost Of Denials Saw 67% Increase In 2022

The average health system saw 110,000 claim denials due to prior authorization and other factors in 2022, a recent study says. KEY TAKEAWAYS: Revenue cycle leaders are placing denials management at the top of the list of areas to improve for 2023. Denials rose to 11% of all claims last year, up nearly 8% from […]
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No-Surprises-Act-Law-Reshaped-Medical-Billing

How The No Surprises Act Law Reshaped Medical Billing

One year ago, the United States marked a turning point for health care cost transparency with a new law aimed at helping Americans avoid unnecessary, unexpected medical debt. As of Jan. 1, 2022, health care providers and insurers are no longer allowed to sideswipe privately insured people with bills for out-of-network services. Experts say the […]
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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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Successful-Alternative-Payment-Models-CMMI

The Successful Alternative Payment Models from CMMI, To Date

The Center for Medicare & Medicaid Innovation (CMMI) has launched more than 50 alternative payment and care delivery model tests, with 33 models now or still operational, according to CMMI’s sixth report to Congress on its progress. These model tests have impacted the lives of millions of patients. In the two-year period covering the report, […]
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