Category: Revenue Cycle Management

Denial Management Services

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 […]
Learn More
Clinical Denials

Clinical Denials: Prevention Is The Best Medicine

Clinical denials are a fact of life for hospitals. Providers must contend with a number of government audits conducted by several different organizations. On the private payer side, hospitals must comply with complex approval processes related to prior authorizations, admission status and medical necessity. At Becker’s Hospital Review’s 10th Annual Meeting in Chicago, R1 RCM hosted a […]
Learn More
MEDICARE PAYMENT

CMS Proposes FY 2020 Medicare Payment Updates For Post-Acute Care

Recently proposed rules would boost FY 2020 Medicare payment rates for several post-acute providers, including skilled nursing facilities and hospices. April showers bring May flowers. But, this year, they are also bringing a slew of new Medicare payment rate proposals, including reimbursement and quality reporting updates for several types of post-acute care providers. CMS recently […]
Learn More
Medicare Quality & Cost

Better Quality, Lower Health Care Costs – Providers & Payers Share Risk

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. News Brief A capitation payment model results in better value […]
Learn More
Blockchain in Healthcare

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 […]
Learn More

3 Tips To Take Your Denial Management Process To The Next Level

In the dynamic realm of medical billing, the persistence of denied claims poses a significant challenge for providers. Research indicates that an alarming portion of claims – exceeding 10% – face initial denial by insurance companies. This leads to revenue loss, wasted administrative efforts, and frustration for both providers and patients. A robust denial management […]
Learn More
x