Tag: healthcare payers

Prior Authorizations

9 Ways To Ease The Prior Authorization Burden

Prior authorizations, or prior approvals, are strategies that payers use to control costs and ensure their members only receive medically necessary care. The cost-control process requires providers to acquire advance approval from payers before delivering specific services or items for a patient. Payers are increasingly using prior authorizations to lower their costs and improve care […]
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Top 13 Reasons For Claim Denials

Top 13 Reasons For Claim Denials

Denied claims are one of physicians’ chief complaints when it comes to dealing with payers. To a certain extent, every practice deals with claim denials. It’s those practices that eliminate the most common reasons that experience a smoother revenue cycle and find greater financial success. Here are the 13 most common reasons for why claims […]
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Medicare-IRF-Proposed-Rule

CMS Posts 2020 IRF Proposed Rule

The focus on electronic health record implementation has turned to how to make use of the vast data stored within to improve revenue cycle operations (IRF). Proposed rule calls amending regulations clarifying the determination as to whether a physician qualifies as a rehabilitation physician is made by the IRF. The Centers for Medicare & Medicaid […]
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Claims Management Automation Progresses, But Opportunities Remain

Providers and payers are increasingly adopting electronic claims management transactions, but remittance advice and prior authorizations are still largely manual. Electronic claims management adoption by plans and providers is at or above 80 percent for three of the seven transactions analyzed in the most recent CAQH Index. The CAQH 2018 Index showed adoption of fully electronic […]
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