Claim denials cast a long shadow over hospital finances, eroding revenue cycles, inflating administrative burdens, and ultimately jeopardizing the institution’s financial stability. While some denials are unavoidable, a powerful and forward-thinking Hospital Claim Validation strategy can dramatically reduce their frequency. This approach emphasizes embedding accuracy and compliance at every touchpoint of the patient journey and […]
The Comprehensive Error Rate Testing (CERT) program grew out of the Department of Health and Human Services Office of Inspector General improper payment rate estimates from 1996 through 2002. Due to sample size restrictions, the Centers for Medicare & Medicaid Services (CMS) assumed responsibility because they had access to more granulated data in 2003. The […]