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 […]
When a claim gets denied, it not only affects the company’s cash flow but also impacts the patient-doctor relationship. Even some denials get claimed by re-appealing but few claims are left on air – that what something your practice and patient would like to avoid. Poor management in claim processing will negatively impact the revenue […]
The patient financial experience and No Surprises Act are top of mind for revenue cycle leaders as we move into 2023. As hospitals try to navigate the COVID-19 crisis, inflation, labor shortages, and rising expenses, organizations are going to finish out the year in the red, according to the latest National Hospital and Physician Flash […]
The American Hospital Association (AHA) and Better Medicare Alliance (BMA) both support the agency’s effort to improve Medicare Advantage (MA). In an attempt to reform MA, CMS released a proposed rule that aims to streamline prior authorization, promote health equity, and curb deceptive marketing. The Biden administration has shown a commitment to increasing oversight of […]
Partnering with a vendor that provides EHR and RCM capabilities helped one healthcare organization boost communication and improve revenue cycle efficiency for 150 care centers. Leveraging automation for revenue cycle management (RCM) processes can streamline tasks and improve efficiencies. Specifically, partnering with an EHR vendor helped a healthcare organization to achieve $1 billion in patient […]
Some commercial health insurers are using policies that can delay patient care and create burden for providers, causing relationships with hospitals to worsen, according to a survey by AHA. The association fielded responses from more than 200 hospitals in 2019 and from 772 hospitals between December 2021 and February 2022, creating data that both predates […]
A focus on front-end revenue cycle efficiency can help to avoid costly medical necessity denials. KEY TAKEAWAYS Four words often describe the efforts to prevent denials related to medical necessity: too little, too late. Mistakes are made early in the patient’s hospital stay, and these mistakes lead to problems down the road. What remains constant […]
‘If you can get it right up front, you’re ensuring accuracy, preventing rework, and preventing denials,’ says Alicia Auman, director of patient access at KSB Hospital. Patient access plays a tremendously important role within the revenue cycle, which is why Alicia Auman, director of patient access at KSB Hospital in Dixon, Illinois, has worked […]
First hand experiences from the country’s most innovative revenue cycles will be shared next month in West Palm Beach, Florida. What issues keep revenue cycle executives up at night? As the HealthLeaders’ revenue cycle editor, I will moderate discussions and hear firsthand experiences of successes, challenges, and the latest ideas coming out of the country’s most innovative […]
Hospital and health system executives should monitor these proposals for provisions that will affect their organizations’ operations. The 2020 annual rule cycle has been active for CMS. Several proposals in the outpatient prospective payment system (OPPS) proposed rule is controversial, although there is at least one provider-friendly change. Here’s a roundup of five regulatory rules […]