Category: Revenue Cycle Management

Denial Management and Strategies

Denial Management and Strategies to Reduce Claim Denials

Denial management is a critical process in the healthcare industry that involves identifying, analyzing, and resolving claim denials. Claim denials occur when healthcare providers’ reimbursement requests are rejected by insurance companies due to various reasons. These denials can have a significant impact on providers’ revenue and overall financial health. In this blog post, we will […]
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The Impact and Challenges of Medicare Advantage (MA) for Payers and Providers

The Impact and Challenges of Medicare Advantage for Payers and Providers

Medicare Advantage (MA) is becoming more appealing to payers due to its numerous benefits, but providers are struggling to adjust to its effects. Payers are increasingly recognizing the advantages of MA, especially in terms of profitability. According to a study conducted by the Kaiser Family Foundation (KFF), MA insurers disclosed an average gross margin of […]
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RCM Strategies

Strategies for Maximizing Revenue Cycle for Financial Success

Based on a recent survey conducted by MGMA, it was found that 40 percent of medical practices were unsuccessful in attaining their revenue objectives in 2021. The survey participants emphasized various significant obstacles, including insufficient staffing, escalating expenses, and delayed payments from payers. To tackle this widespread revenue shortfall, healthcare providers are urged to prioritize […]
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Key to RCM Success

Key to RCM Success: Expertise in Denial Management, Coding & Prior Authorization

A survey conducted by leading healthcare technology company, revealed the top revenue cycle tasks like denials management, coding, and prior authorizations requiring the most subject matter expertise. Out of 15 tasks listed, over 550 healthcares financial and revenue cycle leaders identified denials management, coding, and prior authorizations as the top choices. Denials management was chosen […]
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Critical Thinking Skills prvents denial

Preventing Denial with the Power of Critical Thinking Skills

Lately, I’ve been thinking about how to prevent claim denials, especially considering the high number of claims that were denied in 2021. As coders, we can use critical thinking skills to improve the accuracy of our coding and ultimately reduce claim denials. Critical thinking involves formulating questions, gathering information, applying the information, considering the implications, […]
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Pushing Back Against Medicare Advantage SNF Denials

Pushing Back Against Medicare Advantage SNF Denials: Part 1

Despite ongoing concerns about denials and beneficiary access to care, Medicare Advantage (MA) companies remain in the spotlight as their market penetration continues to grow. In April 2022, a report from the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) highlighted a significant issue in the capitated payment model employed […]
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CHIPS in CMS-2439-P

Know About “CHIPS” in Proposed Rule CMS-2439-P

The Children’s Health Insurance Program (CHIP) was established under the Balanced Budget Act of 1997 (BBA 97) to offer health insurance to children from low to moderate-income families who were ineligible for Medicaid but couldn’t afford private insurance. The program grants federal funding to states, enabling them to establish and enhance their own programs, and […]
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Three Strategies for Streamlining Denials Management

Three Strategies for Streamlining Denials Management

Revenue cycle leaders continue to face significant stress due to regulatory burdens and persistent denials, which are exerting immense pressure on revenue cycles. Despite having a well-functioning front, middle, and back-end revenue cycle, payers often disrupt the process by introducing complexities and constantly changing rules within their intricate, multi-tiered structures. This unpredictable behavior from payers […]
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Revenue Cycle Billing Challenges

Revenue Cycle Billing Challenges: Insights from Patient Experience

To enhance the financial experience of patients, it is crucial to closely examine an organization’s billing procedure. HealthLeaders is joining the celebration of Patient Experience Week from April 23-29 by highlighting the efforts of revenue cycle leaders in establishing a favorable financial experience for patients in their organizations. With a suboptimal financial experience capable of […]
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Healthcare Revenue Cycle Strategies to Boost Revenue

Healthcare Revenue Cycle Strategies to Boost Practice Revenue

Insufficient implementation of revenue cycle management (RCM) strategies may result in disorderliness. Conversely, optimizing RCM in conjunction with billing and collection procedures can mitigate the difficulties, leading to amplified revenue for the practice. The Role of RCM in the Healthcare Sector RCM encompasses both the clinical and business aspects of healthcare institutions, linking patient care […]
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