Category: Blog

insurance coverage denials

How to Fight Surprise Medical Bills and Coverage Denials: A Proven Strategy

Have you recently received a surprising medical bill or had your insurance coverage denials for a recommended treatment? Unfortunately, you’re not alone. A recent national survey by the Commonwealth Fund, a leading healthcare research organization, found that a significant number of insured Americans face these challenges. While many may choose not to contest these issues, […]
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ma reform

Medicare Advantage Reform: Rising Scrutiny and Political Shifts

Medicare Advantage (MA) plans, a type of private health insurance that serves as an alternative to traditional Medicare, have long been a subject of debate within the healthcare industry and among policymakers. However, recent political developments suggest a growing appetite for MA reform, marking a significant departure from previous bipartisan consensus. A Rising Tide of […]
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Financial impact of VBC

Navigating the Financial Impact of Value-Based Care (VBC)

The financial impact of VBC is profound, necessitating adjustments in how providers approach and manage their financial operations to align with this new model of care. The healthcare industry is shifting towards value-based care (VBC), a model that prioritizes high-quality care while aiming to lower costs. In contrast to the traditional fee-for-service model, value-based care […]
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Inflation Reduction Act

Medicare Prescription Drug Benefit Premiums Spike Amid Inflation Reduction Act Changes

Inflation Reduction Act: A Double-Edged Sword for Medicare Beneficiaries: The Biden administration’s recent announcement of the first Medicare drug price cuts, mandated by the 2022 Inflation Reduction Act, has dominated headlines. However, another significant impact of this law—substantial premium hikes for some Medicare beneficiaries—has largely been overlooked. The Inflation Reduction Act represents the most sweeping […]
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CDI and coding

Overcoming CDI and Coding Challenges: The Power of AI-Driven Solutions

Defining the Challenge: Overcoming Obstacles in CDI and Coding: To clarify the overwhelming claims made by technology vendors, I’ve provided some basic definitions. As we embark on this journey, it’s crucial to pinpoint the specific obstacles we face. This will help us demonstrate to senior leadership and stakeholders the need for AI-driven solutions to enhance […]
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MA Prior Authorization Denials

Medicare Advantage Prior Authorization Denials on the Rise

Surge in MA Prior Authorization Denials: New Study Reveals A new study highlights significant variation among Medicare Advantage plans regarding the number of determinations made and the frequency of denials. Notably, MA Prior Authorization Denials surged between 2021 and 2022, according to a recent analysis from health policy research. Researchers examined data from the Centers […]
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Value-Based Care challenges

Value-Based Care: Navigating Challenges and Opportunities in Revenue Cycle Management

RCM and Value-Based Care Challenges and Opportunities: Healthcare is a dynamic field constantly evolving to improve patient and staff experiences. As the industry transforms, it’s crucial to understand both the potential benefits and drawbacks of these changes. One area experiencing significant evolution is Revenue Cycle Management (RCM). The shift towards value-based care models is a […]
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ICD-10-PCS Codes and Guidelines

Latest ICD-10-PCS Codes and Guidelines

The latest ICD-10-PCS codes and guidelines for the fiscal year 2024 have been unveiled by the Centers for Medicare & Medicaid Services (CMS). With a net growth of 73 codes, the total count of inpatient procedure codes has reached 78,603. Notably, the New Technology Section has experienced the largest surge, introducing 40 new codes. The […]
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