All our latest thinking on medical billing, medical coding, accounts receivable and denial management processes, robotic process automation, artificial intelligence, machine learning and more..
The US healthcare industry utilizes Prior Authorization as a means of ensuring optimal and cost-effective use of medical services in accordance with the insurance coverage of each patient. As a rule, healthcare providers must reach out to and obtain approval from the respective insurance companies before they can deliver certain medical treatments or services to their patients.
A typical healthcare provider in the United States is reliant on payors, such as insurance companies, to pay the medical bills of the patients who seek their care. Based on the services they deliver, they make their claims to the payor in prescribed format, requesting reimbursement in accordance with the coverage linked to the patient.
Clinical documentation improvement sounds like a silver bullet for effective revenue cycle management - an easy and straightforward solution for all RCM woes of healthcare providers - but it demands executive willpower, systemic transformation (in many cases) and most importantly, the cooperation of physicians, nurses, coders, and other healthcare personnel.
Patient access services can improve the patient experience by providing clear information, streamlining registration and scheduling processes, and using technology to enhance communication and engagement. By addressing financial concerns and meeting the needs of diverse patient populations, patient satisfaction can be improved.
As we set out to write the trends for 2023, we see that operational efficiency is now the central theme for hospital and healthcare systems leaders. The trends we covered in our 2022 paper continue to get stronger. These included the dawn of the digital health era, the rise of telehealth, the shift to work-from-home models, surprise billing regulations, AI-enabled processing, rogue nation-states leading to increasing cybersecurity risks, and patients now responsible for a rising portion of payments. 2023 is likely to be a very different and fast-paced year and mark a definitive shift in how healthcare is delivered and paid.
An ineffective charge capture program leads to revenue leakage and delays cash realization. While most organizations focus well on back-office functions such as A/R and denial management, they fail to give due attention to the effectiveness of the charge capture process. Missed charges and inaccuracies in charge capture are the primary causes of ineffective charge capture.
A global pandemic forced rapid shifts in an institution that already had been a focal point of calls for change: health care. The panelists brought out perspectives on the impact of COVID-19, emerging technologies in healthcare, hospital finances, shift to value-based care, rise of wearable devices and interoperability.
The post-pandemic path to recovery for hospitals and healthcare systems is steep with multiple challenges, including a severe shortage of clinical and revenue cycle labor, and unprecedented inflation. Initiatives such as value-based care, patient experience improvement, and process automation, on the other hand, are screaming for investments.
Increasing claim write-offs and decreasing success in denial appeals amplify the already sad state of the financials of hospitals and healthcare systems caused by the current labor shortage and trend of declining reimbursements. Shouldn't hospitals be focusing on denial prevention rather than denial recovery? Here are six tips to help you get ahead in the denials game and recover more revenue.
As hospital and health system CFOs prepare for the post-pandemic world, they are witnessing an unprecedented labor crisis and a spiraling backlog of A/R volumes that will bring down the entire organization. Cost pressures, shifts in payer mix, rising consumerism, and declining reimbursements add to their woes. Patient visits have been unpredictable in the post-pandemic world.
Declining reimbursements, rising consumerism, demand for improved patient experience, transition to value-based care, COVID-19's impact, manpower shortage and other factors distract healthcare providers from their core goal of delivering quality healthcare to their patients. They must respond with innovative approaches that could depend largely on finding the right outsourcing partner for the scalability and domain expertise the business needs.
Outsourcing is often associated with the idea of letting go. And letting go is about uncertainty and anxiety about results. By choosing the right partner, you can free up the time and find the investments for the strategic initiatives to propel your organization forward. In our experience, outsourcing can help you in three critical areas - Scalability, Automation, and transparency
