Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Claims Management

Hospitals Write Off 90% More Claim Denials, Costing up to $3.5M

November 21, 2017 - Hospitals strengthened key revenue cycle components over the past two years, but claims denials represented a major threat to their financial health, the recent Revenue Cycle Survey from Advisory Board revealed. Health systems and hospitals wrote off 90 percent more claim denials as uncollectable compared to six years ago, uncovered the survey of healthcare executives at 90 organizations and...


More Articles

KLAS: Quadax, SSI Group Earn Top Scores for Claims Management

by Jacqueline Belliveau

Respondents in a recent KLAS report named Quadax, SSI Group, and ZirMed as the best overall performing claims management vendors because of the high-quality customer service and support provided by the companies. The 296 healthcare organizations...

AHA: OIG Hospital Audit Extrapolation Led to Excessive Claim Denials

by Jacqueline Belliveau

The American Hospital Association (AHA) recently urged CMS to reconsider its extrapolation approach when conducting Office of the Inspector General (OIG) hospital audits because the method leads to excessive repayment requests and claim denials....

EFT Flaws, Paper Enrollment Key Electronic Claims Management Issues

by Jacqueline Belliveau

Electronic claims management adoption continues to face challenges related to healthcare Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA), a new Workgroup for Electronic Data Interchange (WEDI) white paper explained....

HHS Offers Special Medicare Reimbursement After Hurricane Irma

by Jacqueline Belliveau

In the wake of Hurricane Irma, HHS re-opened the National Disaster Medical System (NDMS) Definitive Care Reimbursement Program, a special Medicare reimbursement program that ensures hospitals and other medical facilities receive payment for the...

17% of Practices Pay Fees for Electronic Healthcare Payments

by Jacqueline Belliveau

Approximately 17 percent of physician practices are forced to pay a fee for receiving electronic healthcare payments from their payers, with fees ranging between 2 and 5 percent of the total reimbursement, a recent MGMA poll of over 900 medical...

Real-Time Data for Denials Management Aids Practice’s Lagging A/R

by Jacqueline Belliveau

Without transparency throughout the claim denials management process, healthcare organizations are leaving a significant portion of potential revenue on the table. Limited access to timely claim denial and reimbursement data can prevent providers...

Court to Reconsider Timeline for Medicare Appeals Backlog End

by Jacqueline Belliveau

The DC appeals court recently revoked the court-ordered elimination timeline for the current $6.6 billion Medicare appeals backlog, arguing that the previous court was in error of the law by requiring HHS to do away with the backlog despite the...

Medicaid Reimbursement Woes Key Concern for Healthcare CEOs

by Jacqueline Belliveau

Approximately 85 percent of healthcare executives identified shrinking Medicaid reimbursement rates and funding as a top concern in 2017, according to a new Deloitte survey. Deloitte surveyed 20 CEOs from health systems that collectively produced...

Proactive Healthcare Charge Integrity Captures Missed Revenue

by Jacqueline Belliveau

The key to a successful healthcare charge integrity initiative is the ability to trend chargemaster and coding data, stated Harriett Johnson, the Assistant Director of Revenue Integrity at Novant Health. The trending capability allows health...

$262B of Total Hospital Charges in 2016 Initially Claim Denials

by Jacqueline Belliveau

Approximately 9 percent of hospital charges in 2016 were initially claim denials, according to a new Change Healthcare study. As a result, $262 billion out of $3 trillion in claims submitted last year was denied. The analysis of over 3.3 billion...

86% of Providers Saw Prior Authorization Requirements Increase

by Jacqueline Belliveau

Approximately 86 percent of medical practice leaders reported that prior authorization requirements have increased over the past year, a recent MGMA survey of over 1,000 leaders found. Only 3 percent stated that prior authorization requirements...

Medicare Appeals Backlog Delays Decision Process By 4.5 Years

by Jacqueline Belliveau

Hospitals waited an average of 1,663.3 days, or a little over 4.5 years, to conclude the Medicare reimbursement audit and appeals process because of the extensive Medicare appeals backlog, a recent Journal of Hospital Medicine study uncovered....

3 Best Practices for Hospital Claim Denials Management

by Jacqueline Belliveau

Healthcare cost control continued to top hospital priority lists in 2017. But hospital leaders may be leaving millions of dollars on the table because of inefficient claim denials management processes. Claim denial rates ranged between 0.54 percent...

CMS Pauses Home Health Pre-Claim Review Demonstration

by Jacqueline Belliveau

CMS recently halted the home health Pre-Claim Review demonstration in Illinois for 30 days and the program will not expand to Florida as expected in April 2017, according to the federal agency’s website. “After March 31, 2017, and...

Top 4 Claims Denial Management Challenges Impacting Revenue

by Jacqueline Belliveau

For most healthcare organizations, claim denials are a normal, if not a frequent, occurrence. While very few can boast that their denial rates are close to zero, many providers face a number of challenges with implementing an effective claims...

Payer, Provider Dialogue Key to Prior Authorization Reform

by Jacqueline Belliveau

ORLANDO - Prior authorization reform has recently been a hot topic for many healthcare industry groups and it was no different at HIMSS17. To find out more about what providers and payers plan on doing to alleviate the administrative and care...

AMA: Eliminate Prior Authorization for Opioid Abuse Treatment

by Jacqueline Belliveau

The American Medical Association (AMA) recently called on attorney generals across the nation to follow in New York’s footsteps with reforming prior authorization requirements for medication-assisted treatment for opioid abuse. New York’s...

Healthcare Groups Offer 21 Prior Authorization Improvements

by Jacqueline Belliveau

A coalition of 17 healthcare industry groups recently called on health plans, benefit managers, and other healthcare stakeholders to change prior authorization requirements to improve care continuity, reduce provider burdens, and improve timely...

HHS Finalizes Solutions to Decrease Medicare Appeals Backlog

by Jacqueline Belliveau

In effort to reduce the significant Medicare appeals backlog, the Department of Health and Human Services (HHS) recently finalized several appeals process changes. Major modifications included using precedential decision-making at the Departmental...

Continue to site...