A new analysis shows that claim denial rates for in-network services among Healthcare.gov marketplace payers varied significantly, with some as high as 80%. Claim denial rates varied significantly among Healthcare.gov marketplace payers, with...
More InfoHow to avoid medical necessity denials and ensure timely payment. Sick visit on the same day as an annual wellness visit (AWV) Reason for denial: Lack of clear clinical documentation regarding why the physician had to go above and beyond what is...
More InfoThe No Surprises Act went into effect in December 2021 and may have prevented millions of surprise billing claims in its first two months. May 24, 2022 – Since the No Surprises Act went into effect, the law has prevented more than two...
More InfoEmergency medicine is facing a host of claims reimbursement updates this year, from looming Medicare payment cuts to new rules about the split and critical care visits. Emergency department providers are still reeling from the effects of the...
More InfoPayers, providers, and members can all benefit from transforming the manual and patchwork claims payment process to a digital environment that also automates claims data delivery. Payers, providers, and members are all central to the healthcare...
More InfoThe American Hospital Association (AHA) has asked CMS to include Medicare Advantage organizations in its proposed rule that would streamline the prior authorization process and reduce patient care delays. In December 2020, CMS released a notice...
More InfoMore than 80% of leading health systems that are using RPA/AI say their primary reason for investing in the technology was improving financial performance, but once the technology was in use, they said efficiency was the top benefit. The reasons...
More InfoHHS reduced the Medicare appeals backlog by 79 percent during the third quarter of FY 2021, putting the department ahead of schedule to clear the backlog. As of June 30, 2021, the end of the third quarter of FY 2021, HHS had 86,063 pending...
More InfoHealthcare B2B payment transactions have been high in 2021, potentially signaling the importance of electronic payment transfers as the nation emerges from the coronavirus pandemic, according to a report from National Automated Clearing House...
More InfoAverage claim denial rates are between 6% and 13%, but some hospitals are nearing a “danger zone” after COVID-19, a survey shows. Hospital claim denial rates are at an all-time high, signaling a need for better claims denial management, a recent...
More InfoThe COVID-19 pandemic created a host of challenges for revenue cycle management leaders, from widespread service line shutdowns to shifting staff to work at home and increasing self-pay balances. These pressures have heightened inefficiencies in...
More InfoMost physicians still faced a high prior authorization burden despite treating a surge of positive COVID-19 cases this winter, the American Medical Association (AMA) reports. In a survey of 1,000 practicing physicians between Nov. 23, 2020, and...
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