Despite ongoing concerns about denials and beneficiary access to care, Medicare Advantage (MA) companies remain in the spotlight as their market penetration continues to grow. In April 2022, a report from the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) highlighted a significant issue in the capitated payment model employed […]
Revenue cycle leaders continue to face significant stress due to regulatory burdens and persistent denials, which are exerting immense pressure on revenue cycles. Despite having a well-functioning front, middle, and back-end revenue cycle, payers often disrupt the process by introducing complexities and constantly changing rules within their intricate, multi-tiered structures. This unpredictable behavior from payers […]
Ensure you make a well-informed choice when selecting a company to manage your reimbursements. Physicians seeking to improve their reimbursement rates, financial performance, operational efficiency, or focus on patient care should consider outsourcing their billing needs. However, choosing the right physician billing service for your practice can be a challenging task, as not all services […]
Having been on the receiving end of audits, and also having been an individual who has conducted them, I know the mindset from both sides of this equation. The one element to this equation that has changed over time is the increase in payer denials: those that are now clinical- and coding-focused, often resulting in […]
Revenue cycle leaders were asked to rank the most time-consuming tasks at their organization, and the results aren’t surprising. 556 chief financial officers and revenue cycle leaders at hospitals and health systems across the United States were asked to rank the most time-consuming revenue cycle tasks at their organizations in a new survey commissioned by […]
Two letters. They’re enough to give your patients more anxiety than any treatment, test or injection. A recent survey by the Pew Research Center shows it: Sixty percent of Americans said they would be uncomfortable with their provider relying on artificial intelligence (AI) in their own health care. But when used responsibly, artificial intelligence can […]
How do you resolve a repeated and shooting up problem like claims denials? It’s been a fresher subject for revenue cycle management professionals for years that are only experiencing hotter with the growing pressures of staffing shortages, troubles with staff movement and instructing and developing policies and protocols at the government and payer levels. On […]
Denial rates serve as a barometer for the financial well-being of healthcare organizations. An increase in denials can have wide-ranging negative implications for an organization — impacting everything from accounts receivable to the patient experience. By preventing denials upfront, providers can realize revenue faster, boost staff efficiency and satisfaction, and reduce patient anxiety related to […]
Medicaid expansion improved financial performance for healthcare providers and was associated with lower uncompensated care costs and higher revenues. Medicaid expansion has positively impacted healthcare providers by boosting financial performance and resulting in payer mix improvements, data from the Kaiser Family Foundation (KFF) found. All but 11 states have expanded Medicaid eligibility as of January […]
A recent survey highlighted how payment cuts are affecting denial strategies. Healthcare organizations are on the verge of stepping up their denials management strategies in 2023 as rate cuts are expected to impact revenue. On the delivery side, most practices plan to continue their telehealth operations in the New Year, according to the 2023 Part […]