The healthcare industry holds hidden potential for improved revenue and streamlined operations. Charge capture audits act as your key to unlock these hidden treasures. Similar to explorers seeking buried riches, healthcare organizations can embark on a quest for financial stability through these audits. This guide will explain charge capture audits, help you identify hidden opportunities, […]
RCM optimization: While maximizing revenue is paramount in today’s competitive business environment, many organizations experience inefficiencies in their RCM processes. Here’s where data becomes your secret weapon. With data-driven strategies, you can maximize your revenue cycle management (RCM), unlock revenue potential, and grow significantly. Understanding RCM and its Impact on Revenue In Revenue Cycle Management […]
The Prime Minister’s recent voluntary national survey shed light on the Denied claims. The survey, conducted between October and December 2023, found that nearly 15% of all Medicare Advantage, Medicaid, Commercial and Managed Medicaid claims were denied. Between 45% and 60% of rejected cases were overturned, although the expensive appeals process sometimes meant multiple appeals. […]
Getting bogged down by authorization denials? You’re not alone. Here, we explore common roadblocks and effective strategies to keep your revenue flowing smoothly. Challenge: Drowning in Last-Minute Authorizations Solution: Divide and Conquer with a Multi-Team Approach Separate teams can tackle present and future authorizations. The “Today” team verifies benefits and identifies authorization needs for upcoming […]
RCM Company has been at the cutting edge of making a difference in healing centers and wellbeing frameworks addressing patient-involved (coordination of benefits) and clinical dissents, recouping on low-balance accounts, and resolving complex claims. Getting these ranges of the income cycle settled rapidly and effectively is becoming tall need these days, as healthcare providers confront […]
In the intricate realm of healthcare, where patient well-being is closely entwined with administrative complexities, the cornerstones of success lie in effective revenue management and specialized revenue cycle management services. This pivotal link between clinical operations and financial viability is established through the practice of healthcare revenue cycle management (RCM) and services offered by specialized […]
The findings demonstrate a growing interest in digitally transforming outpatient RCM to improve efficiencies and optimize revenue. About 22% of revenue cycle leaders who manage their inpatient revenue cycle management already outsource some of their outpatient RCM, and 12% have ambitions to do so in the future, find a new survey conducted by the Healthcare […]
Payment integrity in Medicaid—the concerted effort to keep tight control over fraud, waste and abuse—can be addressed at any stage in the claim cycle. Of course, the earlier it is addressed, the easier it is for health plans to avoid improper payments and the administrative burden of recovering them. And while pre-payment integrity programs maximize […]
A focus on front-end revenue cycle efficiency can help to avoid costly medical necessity denials. KEY TAKEAWAYS Four words often describe the efforts to prevent denials related to medical necessity: too little, too late. Mistakes are made early in the patient’s hospital stay, and these mistakes lead to problems down the road. What remains constant […]
A report by the Office of Inspector General (OIG) raises concerns about organizations prioritizing profits over patient access to care. Medicare Advantage organizations (MAOs) often delay or deny services for medically necessary care, even when prior authorization requests meet coverage rules, according to a report by the OIG. A concern with the Medicare Advantage […]