Category: Blog

Importance of Preauthorization in Healthcare RCM

Importance of Preauthorization in Healthcare RCM

Preauthorization is a process in which a healthcare provider obtains approval from the patient’s insurance company before providing certain services or procedures. This process is important for both the patient and the provider, as it helps to ensure that the services are covered by the patient’s insurance plan and that the provider will be reimbursed. […]
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4 Revenue Cycle Startegies that Conquer Denials Management

Ensuring effective denial management continues to be the foremost concern for revenue cycle leaders, emphasizing the increasing demand for streamlined processes and vigilant oversight. Over the recent months, there has been a notable surge in challenges related to denials management, presenting a multifaceted and costly issue for revenue cycle leaders. Seeking Cost-Effective Solutions? Explore the […]
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Advancing Prior AuthorizationThe Evolution in CMS Regulation

Advancing Prior Authorization: The Evolution in CMS Regulation

The Centers for Medicare & Medicaid Services (CMS) have embarked on a decisive move by enforcing a standard for Advancing prior authorization. In a conversation with the Senior Director of Utilization Management, we discussed the potential implementation and impact of this proposed mandate, slated for enactment in January 2026 The Predicament of Prior Authorization The […]
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Top ACA Compliance Mistakes to Avoid in 2024

 As the 2024 calendar year’s open enrollment period swiftly approaches, it is imperative for organizations to focus on ensuring compliance with the Affordable Care Act (ACA) in order to guarantee that their procedures for managing health plans are well-executed. Despite nearly a decade of ACA reporting, organizations still tend to make errors in Affordable Care […]
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UHC Commercial Plan Focuses on Price Transparency and Preventive Care

Commercial Plan Prioritizes Affordable Healthcare and Preventive Measures

The emphasis on preventive care by the payer likely contributed to its high re-enrollment rate. Insurance Company’s employer-sponsored healthcare plan, compliant with the Affordable Care Act, has emerged as the fastest-growing commercial plan for the payer. Data from the payer’s Impact Study suggests that the healthcare plan company’s focus on both price transparency and preventive […]
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Outpatient ICD-PCS Codes

2024 Outpatient Surgery ICD-10 PCS Coding Updates

As we approach the year 2024, it is important for healthcare professionals to stay up-to-date on the latest coding updates for outpatient surgeries using the International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10 PCS). These updates are crucial for accurate and efficient billing, reimbursement, and data analysis. The following is a summary of […]
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Optimizing Healthcare Revenue Cycle: Interoperability Standards and AI Revolution

Interoperability standards and AI wield significant influence over the revenue cycle, holding the potential to transform the financial landscape of healthcare establishments. In the constantly evolving realm of healthcare, the infusion of artificial intelligence (AI) has emerged as a game-changing force, promising to revolutionize patient care, diagnoses, and treatments. However, to fully harness the power […]
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Power of Healthcare Revenue Cycle Management in 2024

In the intricate realm of healthcare, where patient well-being is closely entwined with administrative complexities, the cornerstones of success lie in effective revenue management and specialized revenue cycle management services. This pivotal link between clinical operations and financial viability is established through the practice of healthcare revenue cycle management (RCM) and services offered by specialized […]
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