The US healthcare industry is making a definite shift towards value-based care, where the quality of healthcare delivered to patients and the results achieved take center stage, marking a clear departure from the traditional fee-for-servicess approach.
The Mounting Crisis of Prior Authorization Denials
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.
Benchmark to Transform: A Guide for Revenue Cycle Leaders
Thriving Not Just Surviving: A New Playbook for Financial Transformation in Healthcare
Maximizing Revenue: Strategies for Identifying and Recovering Underpayments in Healthcare
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.
Implementing CDI Programs: Challenges, Strategies, and Benefits
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.
Resolving Medical Necessity Denials - Role of Coding and Clinical Documentation
Effective Charge Capture and CDMs – The key to revenue cycle success for hospitals
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.
Six Aspects of an Effective Denial Prevention Program
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.