Category: Revenue Cycle Management

Benefits-of-Medicare-Advantage

Enhancing Medicare Advantage Benefits for Patients and Providers

The AMGA says that expanding Medicare Advantage benefits would benefit patients, physicians, and others in the health care industry. For Medicare Part C, also known as Medicare Part C, and Medicare Prescription Drug Benefit Program (Medicare Part D), some policy and technical changes have been approved for 2025 by the association. A public comment period […]
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CMS-introduces-game-changing-appeal-rights-for-Patients

CMS Enhanced Patient Appeal Procedures

Doctors must consider the implications of altering a patient’s status. The Centers for Medicare & Medicaid Services (CMS) is suggesting novel retrospective and prospective appeal procedures in compliance with a federal district court order from the District of Connecticut. On December 21, the agency unveiled a proposed rule aiming to institute an appeal mechanism for […]
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3-strategies-for-revenue-cycle-management-optimization

3 Strategies for Revenue Cycle Management Optimization

Optimizing revenue cycle management is crucial for recovering from the significant losses of the previous year. Leading provider organizations have developed three effective strategies to address this challenge. In the wake of the COVID-19 pandemic, fine-tuning revenue cycle management has become a priority for financial leaders. Last year, healthcare institutions faced substantial declines in revenue […]
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Top-3-Revenue-Cycle-Hurdles

Top 3 Critical Challenges for Revenue Cycle Leaders in 2024

Revenue cycle leaders ought to contemplate including these three challenges in their organization’s roster of New Year’s resolutions. 1. Automating Payer Processes: Similar to healthcare organizations, payers have also started embracing automated solutions, intensifying challenges in managing denials and causing delays in payment for rendered care. At the 2023 Revenue Tech Exchange in Raleigh, leaders […]
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Impacts of Claim Denials on Revenue Cycle

How Claim Denials and Payer Audits Impacts Healthcare Revenue Cycle

Denial rates, notably within Medicare Advantage, are on the rise, impacting both hospital revenue cycles and patient care, remarked the executive director of a Minnesota-based large multispecialty health care organization focused on Revenue Cycle management. Despite the organization reporting a favorable margin this year, it falls short in achieving profits comparable to those of insurers, […]
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Denial Management in RCM

Navigating Denial Management Challenges in Revenue Cycle Management

Denial management in rcm: In the intricate realm of healthcare revenue cycle management (RCM), the substantial challenge revolves around handling denied claims. Scarcity of resources, understaffing, and restricted capacity frequently lead to difficulties in resolving denied claims, where an alarming 82% to 90% are considered potentially preventable. RCM teams can optimize time and revenue recovery […]
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Steps-to-reduce-claim-denials

Effective Revenue Cycle Management Strategies to Reduce Denials & Boost Revenue

Healthcare organizations consistently grapple with the complexity of overseeing their revenue cycles—a comprehensive process spanning patient registration, appointment scheduling, and concluding with balance payments. Yet, a pivotal hurdle disrupting this cycle’s seamless operation is the prevalent occurrence of claim denials. Vital for any healthcare institution’s financial well-being is the imperative to diminish these denials and […]
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Value-Based-Care-Plans-improved-health-outcomes-for-MA-members

Medicare Advantage Value-Based Care: Enhanced Health Outcomes

Alongside its positive impact on health outcomes, the Medicare Advantage value-based care plans implemented by an insurance provider resulted in a significant $8 billion in cost savings throughout 2022. Reports from the payer revealed that Medicare Advantage beneficiaries under value-based care exhibited improved health conditions, marked by reduced inpatient admissions and emergency room visits. The […]
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