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 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 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 InfoDays in accounts receivable (A/R) is one of the most important key performance indicators for growing practices. In an increasingly complex healthcare environment—and one in which financial responsibility is shifting to the patient—keeping track...
More InfoTypical CDI programs are intended to drive reimbursement through diagnosis securement, contributing to improved case mix index. The COVID-19 pandemic is placing monumental financial stressors upon hospitals, with added costs to treat patients...
More InfoIf there’s one thing healthcare providers can agree on, it’s that prior authorization management is a heavy administrative burden and only growing heavier. Decades ago, it was created to ensure care standards continuity, improve safety and...
More InfoThere’s nothing more frustrating than rendering a service and not being paid. Sometimes the problem comes down to a single code. Nuanced coding rules are difficult to understand, and physicians aren’t taught this information in medical school...
More InfoIn COVID-19’s wake, providers’ financial recovery will be crucial yet daunting. U.S. hospitals and health systems stand to collectively lose $36.6 billion between March and June 2020 alone. Physician practices also face serious financial...
More InfoRevenue cycle management encompasses everything related to the order-to-cash process. For success in revenue cycle management, constant and vigilant oversight of the key processes is needed. With that oversight, continuous process improvement can...
More InfoThe healthcare industry is unlike any other. In other businesses, you provide a product or service and the customer puts cash in your hand (more or less). However, the healthcare industry is very different. With multiple providers, claims to...
More InfoArtificial intelligence (AI) is a concept that has moved very quickly from the realm of science fiction into real and practical utility in a number of different industries—including healthcare. One of the most effective applications for...
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