Tag: Denial Management Services

Why Healthcare Providers Need Medical Claim Clearinghouses

Medical claim clearinghouses enhance the efficiency of claim submissions for healthcare providers, thereby reducing costs and improving payment accuracy. Each year, healthcare payers and providers exchange billions of claims to finalize patient encounters, a number that continues to rise. As claim volumes increase annually (except for a dip in 2021 due to the COVID-19 pandemic), […]
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3 Coding Compliance Strategies to Improve Reimbursement, Quality

The Crucial Role of Medical Coding Compliance in a Value-Based World: Telling the Patient’s Story for Better Billing and Quality Care. Medical Coders: The Unsung Storytellers of Healthcare Medical coders play a critical role in hospitals, but their importance often goes unnoticed. They’re the storytellers behind the scenes, analyzing patient records, selecting billing codes, and […]
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Improve-RCM

Boost Your Bottom Line: 4 Keys to Healthcare RCM Success

In 2024, factors like declining reimbursement rates, the shift towards value-based care, and ever-changing regulations demand a proactive approach to improve RCM. Here, we explore four key strategies to optimize your healthcare revenue cycle and ensure financial stability in the coming year. 1. Break down Silos: Merging Front-End and Back-End Functions Many healthcare organizations struggle […]
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5 Ways to Reduce Claims Denial in Your Revenue Cycle

Reduce Claims Denial in Your Revenue Cycle

Claims Denial: Healthcare Leaders report an increase in payer denials, putting increasing pressure on the system’s finances. Going back and forth with denied payers is a long and expensive process, and low reimbursement rates don’t help either. In a new survey conducted by the Healthcare Financial Management Association, CFOs noted a significant increase in denials, […]
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Strategies-to-optimize-RCM

Strategies For Optimizing Revenue Cycle Management

In today’s healthcare environment, optimizing revenue cycle management (RCM) is no longer a luxury. It is necessary rising costs, complex regulations and rising patient deductibles are forcing healthcare organizations to spend every penny they can. Fortunately, you can use some effective strategies to streamline your RCM process, reduce errors, and increase profitability. Understanding currency conversion: […]
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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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Enhancing Claims Management

Enhancing Claims Management: Identifying Errors, Maximizing Efficiency, and Streamlining Operations

Claims management serves as a valuable tool for insurance firms, enabling them to identify the root causes of claim errors, measure areas for improvement, and explore new opportunities to continuously enhance their operations. However, the ever-increasing complexity of claims administration poses a formidable challenge for insurance businesses, hindering their ability to uncover fresh prospects and […]
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cms-prior-authorization-operational-and-financial-impact

CMS Prior Authorization—operational And Financial Impact

CMS has expanded the prior authorization requirement to two new service categories within hospital outpatient department services. The Centers for Medicare & Medicaid Services (CMS) has expanded the prior authorization requirement for two additional hospital outpatient department (OPD) services. Effective with date of service July 1, 2021, CMS has expanded the prior authorization requirement to […]
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Medicare Advantage Plan

Medicare Advantage Plan Denials: Is That Convoluted or What?

Medicare Advantage Plan contracts are “take-it-or-leave-it” agreements Many questions are swirling about regarding Medicare Advantage Plan (MAP) denials asking what to do about the increasing number and given reasons.  I’ve heard or read some amazing stories where payers have gone to astounding lengths to deny claims.  Answers are also swirling about based on understandings of […]
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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 […]
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