Tag: Claims Reimbursement

Mastering Chronic care management codes

Chronic Care Management Codes: A Comprehensive Guide

Chronic Care Management codes are increasingly being adopted by healthcare providers to address care fragmentation for patients with multiple chronic conditions. However, a recent study published in the American Academy of Family Physicians suggests that while CCM is gaining traction, challenges persist in its implementation and reimbursement. A Growing Trend The study, which analyzed Medicare […]
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Survey: High Initial Claim Denials Impact Healthcare Providers

The Rising Denial Rates in Healthcare Claims Processing Initial Claim Denials: In a new survey conducted by healthcare Company an increased percentage of initial claims are denied by private payers, including pre-approvals for medical claims. Hospitals, health systems, and post-acute care providers may have a difficult time getting paid for medical services. The survey respondents […]
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Claims Reimbursement Speed and Denial Rate

The Impact of Location on Claims Reimbursement Speed and Denial Rate

A recent examination has revealed a significant link between the operational location of healthcare providers and the speed and accuracy of claims reimbursement by insurers. If your practice encounters delays in claims reimbursement, this may be attributed to the geographical area in which your practice is situated, according to a recent scrutiny of financial transactions. […]
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Automating-Claims-Management-Processes-May-Reduce-Costs

Automating Claims Management Processes May Reduce Costs

The adoption of electronic transactions increased in 2021, but further automation of claims management processes could save healthcare providers nearly $25 billion annually. Automating claims management processes could help healthcare providers curb the high spending on administrative transactions they saw in 2021, according to the 2022 Index report from the Council for Affordable Quality Healthcare, […]
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Public-Coverage-Increase | Case Studies | AllZone Management Services Inc.

Uninsured Rate Falling as Public Coverage Increases

The percentage of people covered by some type of health insurance in 2021 was higher compared to 2020, with public coverage rising significantly. It stands to reason that providers are treating more patients with health insurance. The percentage of people covered by some type of health insurance in 2021 was higher compared to the previous […]
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State Surprise Billing Laws for Out of Network Payment | Case Studies | AllZone Management Services Inc.

State Surprise Billing Laws Impact Out-of-Network Provider Charges

Provider charges for out-of-network care increased by $1,157 after the passage of state surprise billing laws that allow arbitrators to consider provider charges in a surprise billing dispute. State surprise billing laws that allow arbitrators to consider provider charges when determining out-of-network payment amounts for surprise medical bills led to an increase in billed charges […]
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Final Surprise Billing Rules QPA

Biden Administration Releases Final Surprise Billing Rules

The final surprise billing rules downgrade the weight the QPA has on out-of-network payment determinations and establishes documentation requirements for down coding situations. The Biden Administration has released final surprise billing rules implementing the No Surprises Act, a federal law enacted in January 2021 that protects patients from out-of-network medical bills when they seek care […]
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Claim-Denial-Rates-for-In-Network-Service

Claim Denial Rates as High as 80% for In-Network Services

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 some insurers racking up rates as high as 80 percent, according to a new analysis from Kaiser Family Foundation. Marketplace payers must […]
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