Tag: Revenue Cycle Management

Using Artificial Intelligence To Advance Revenue Cycle Management

Using Artificial Intelligence To Advance Revenue Cycle Management

Artificial intelligence (AI) is making big waves in healthcare from detecting lung cancer and gene mutations that lead to autism to addressing social determinants of health and chronic conditions. The technology is automating and optimizing clinical workflows, leading to improved outcomes, lower costs, and enhanced patient and provider satisfaction. The critical role artificial intelligence now plays in healthcare prompting some providers to […]
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AMA on Evaluation and Management Service Codes Guidelines

AMA on Evaluation and Management Service Codes Guidelines

Medical coders who were unsure what documentation non-Medicare payers would expect in light of the Patients Over Paperwork Initiative now have more to go on. The initiative reduced documentation requirements for outpatient evaluation and management service codes (CPT® 99201-99215) provided to Medicare Part B patients beginning in 2021. The Centers for Medicare & Medicaid Services (CMS) indicated in their initiative that, although […]
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How to Prevent and Manage Claim Denials

How to Prevent and Manage Claim Denials

For many healthcare providers, claim denials are a frustrating cost of doing business. Each year, around 5-10% of medical billing claims are rejected (possibly more). With each claim costing around $25 to rework, providers lose billions in eroded revenue and productivity. Any revenue leakage is bad enough, but the shift towards value-based care means tighter revenue cycle management […]
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How AI Reshaping Hospital Revenue Cycle

How Artificial Intelligence, Analytics & Automation are Reshaping Hospital Revenue Cycle

The accelerating challenge around patient needs’ calls for new technology and automation, but on a personal level. As hospitals turn to technology to overhaul the patient experience and improve profits, a range of vendors are bringing new products and outsourced services to meet that demand with artificial intelligence, data analytics and natural language processing as […]
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Top 13 Reasons For Claim Denials

Top 13 Reasons For Claim Denials

Denied claims are one of physicians’ chief complaints when it comes to dealing with payers. To a certain extent, every practice deals with claim denials. It’s those practices that eliminate the most common reasons that experience a smoother revenue cycle and find greater financial success. Here are the 13 most common reasons for why claims […]
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A Rebeginner Guide to Peer-to-Peer Appeals

A Rebeginner’s Guide to Peer-to-Peer Appeals

Suggestions for conducting peer-to-peer appeals for denials. If you are wondering why you should read this if you think you are not a rebeginner, well, it is because you actually are one. Beginnings do not disappear, they just reproduce. Novices are just starting, veterans have started over and over. We all begin as beginners and […]
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Urgent Need for New Revenue Streams will Shape Providers Strategies

Urgent Need for New Revenue Streams will Shape Providers Strategies

Building alternative revenue streams source will play a bigger role in healthcare providers’ strategies, according to a new study. Ninety percent of hospital and health system executives surveyed indicated that new revenue streams were an urgent priority expected to yield a return in the next three years, a new study from Boston-based Partners Health Care […]
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How Blockchain Can Solve Healthcare’s Data Reconciliation Problem

How Blockchain Can Solve Healthcare’s Data Reconciliation Problem

The U.S. healthcare industry has a $1 trillion opportunity to cut costs and reduce waste, according to a 2015 Harvard Business Review analysis. While there are various areas waste accumulates, costly data reconciliation is a prominent problem for hospitals and health systems. Change Healthcare defines data reconciliation as “the process of compiling information across companies […]
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New Rules Issued for Modifiers 59, XE, XS, XP, and XU

New Rules Issued for Modifiers 59, XE, XS, XP, and XU

The Centers for Medicare & Medicaid Services (CMS) issued a policy change modification to the claims processing logic for Modifier 59 Distinct procedural service (and the optional patient-relationship modifiers XE, XS, XP, and XU) on February 15, 2019. These modifiers are only processed when applied to the Column 2 code in a bundled pair, per Correct Coding Initiative […]
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