Claims Management

Private payers initially deny nearly 15% of medical claims

March 25, 2024 - It may take some time to get paid for medical services, suggests a new survey of hospitals, health systems and post-acute care providers. Nearly 15 percent of medical claims submitted to private payers for reimbursement are initially denied, respondents representing over 500 organizations told Premier Inc. in the survey. An average of 3.2 percent...


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Breaking Down the Back-End Revenue Cycle, Key Best Practices

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When outsourcing revenue cycle management services, ambulatory provider organizations want vendors that excel in communicating, have adequate expertise, and can successfully educate clients, a KLAS...

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Healthcare Administrative Spending Increased by 50%

by Jacqueline LaPointe

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Providers See Fourfold Increase in External Payer Audits

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2023 has been a big year for healthcare revenue integrity, with teams managing about four times more external payer audits in the last year. The finding from the latest “MDaudit Annual Benchmark...

Medicare Advantage Denials Jump 56%, Commercial Denials 20%

by Jacqueline LaPointe

Hospitals and health systems have seen a significant spike in claim denials as Medicare Advantage and commercial payers deny more of their reimbursement. A new analysis of data from over 1,300...

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Revenue cycle leaders at top healthcare organizations are prioritizing automation, with autonomous coding and claims management at the top of their wish lists, a new KLAS report reveals. KLAS surveyed...

Patient Access, Registration Errors Lead to Most Claim Denials

by Jacqueline LaPointe

Hospitals and health systems are facing more claim denials as front-end revenue cycle processes lead to errors. A recent survey conducted by the Healthcare Financial Management Association’s...

62% of Hospitals Don’t Automate Any Part of Denials Management

by Jacqueline LaPointe

Most hospitals and health systems are not automating any component of denials management, according to a recent survey of healthcare finance and revenue cycle leaders. Commissioned by technology...

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Does your practice experience claims reimbursement delays? That may be because of where your practice operates, according to a recent analysis of financial transaction data. The new Crowe report,...

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Claim denials are posing a serious and expensive problem for healthcare revenue cycle management (RCM), according to a recent survey of healthcare leaders. A survey conducted by Plutus Health...

What the Latest Court Decisions Mean for the Federal IDR Process

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CMS Announces Start Date for IRF Claims Review Demo

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by Jacqueline LaPointe

The American Medical Association (AMA) and more than 100 other provider trade associations have taken issue with a new policy from The Cigna Group regarding claims with modifier 25. Cigna recently...

Revenue Cycle Leaders Spend the Most Time on Denials Management

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