Tag: Providers

The Impact and Challenges of Medicare Advantage (MA) for Payers and Providers

The Impact and Challenges of Medicare Advantage for Payers and Providers

Medicare Advantage (MA) is becoming more appealing to payers due to its numerous benefits, but providers are struggling to adjust to its effects. Payers are increasingly recognizing the advantages of MA, especially in terms of profitability. According to a study conducted by the Kaiser Family Foundation (KFF), MA insurers disclosed an average gross margin of […]
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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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New-Patient-EM-Denials

New Patient E/M Denials: Mystery Solved

New patient evaluation and management (E/M) claims are being denied when the patient was previously seen by a specialty physician assistant or specialty nurse practitioner on staff. This is happening when another provider of a different specialty in the same multi-specialty group sees the patient for the first time and bills a new patient E/M […]
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