Tag: Denial Management

Automation in Prior Authorization

Industry Voices – Advancing Automation for Prior Authorization

If 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 regulate costs but has become an unwieldy process filled with manual tasks and roadblocks that dilute the original intent. […]
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2020 Coding Guide

2020 Coding Guide: Get Paid What You’re Owed

  There’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. Still, health care is a business. As business owners, physicians need to know how they’re paid, including […]
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Telehealth RCM

Maximizing Telehealth Success: How to Optimize Operations & Revenue Cycle Management

  In 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 challenges as they recoup revenues that declined up to 55 percent and patient volume that decreased 60 percent. Amid these hardships, telehealth has emerged as […]
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AI in RCM

Artificial Intelligence: The Benefits to Revenue Cycle Management

Artificial 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 AI-powered tools is in the field of revenue cycle management. Sophisticated AI technologies can sift through vast amounts of […]
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Denial Management Services

Developing A Hospital Claim Validation Strategy To Prevent Denials

A comprehensive hospital claim validation strategy that prevents denials and improves efficiencies hinges on the right blend of retrospective and pre-bill reviews. The time to strengthen hospital compliance programs through claim validation is now. According to healthcare finance and information management leaders surveyed by HIMSS Media, clinical documentation and coding were the revenue cycle processes most vulnerable […]
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Medical Coding Roght

Boost Revenue By Getting Coding Right

It’s every physician’s worst nightmare: Receive payment for services rendered, but then a payer identifies an aberrant pattern in claims data, audits the records, decides it has overpaid the practice, and recoups those funds. That money you already allocated for overhead, staff salaries, bonuses, or new medical equipment? Gone. With one post-payment audit, you now […]
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Artificial Intelligence in RCM

How AI Can Create A Massive Competitive Advantage – 4 Financial Applications

Healthcare organizations have a tremendous opportunity to harness artificial intelligence in an area that may not seem flashy but is important nonetheless: revenue cycle management. Although 94 percent of companies firmly believe AI can give healthcare organizations a “massive competitive advantage,” according to Change Healthcare’s Adam Sullivan, PhD, less than 5 percent have extensively incorporated […]
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Denial Management Services

Medical Necessity and Denial Management

Quality work reduces the burden of the denial management process. When my children were young, they really enjoyed the movie “The Neverending Story.” It’s about a boy who reads a magical book that tells a story of a young warrior whose task is to stop a dark force called “The Nothing” from engulfing a mystical […]
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