Access to beneficial healthcare is largely tied to insurance reimbursements for many Americans. Yet, despite their significance, physicians encounter various obstacles in obtaining these payments. Challenges involve inconsistent reimbursement schedules, payment audits, billing errors, unforeseen denials, lengthy appeals, and services falling outside coverage. These issues can hinder timely care, disrupt service continuity, and leave medical […]
Collaboration among a diverse team that blends clinical expertise and technical proficiency is essential in today’s dynamic healthcare environment to overcome administrative and diagnostic challenges. This multidisciplinary approach facilitates the creation of healthcare technology solutions that benefit all stakeholders, including payers, providers, and patients. By adopting a more personalized approach, treatment outcomes can be optimized […]
The Centers for Medicare & Medicaid Services (CMS) has finalized a number of proposals in its rule governing the Affordable Care Act (ACA) exchanges in 2022, including lower user fees. In the final rule, the CMS set user fees for qualified health plans at 2.25% of the premium, down from 3%. The agency said […]
Clinical denials are a fact of life for hospitals. Providers must contend with a number of government audits conducted by several different organizations. On the private payer side, hospitals must comply with complex approval processes related to prior authorizations, admission status and medical necessity. At Becker’s Hospital Review’s 10th Annual Meeting in Chicago, R1 RCM hosted a […]