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...
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...
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...
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...
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...
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...
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...
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,...
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...
In an official blog post, CMS recently touted its success with improving primary care provider productivity by giving practices in the Comprehensive Primary Care (CPC) program more multi-payer claims...
Healthcare providers could save about $7.9 billion annually by switching to automated claims management processes, particularly for prior authorizations, remittance advices, and claim attachment...
A federal court recently denied a Department of Health and Human Services (HHS) request to reconsider the four-year timeline developed to eliminate the Medicare appeals backlog at the administrative...
The Department of Health and Human Services (HHS) must eliminate the Medicare appeals backlog at the administrative law judge review level by Dec. 31, 2020, a federal judge recently decided.
The most...
In an effort to resolve the Medicare appeals backlog, CMS recently reopened a settlement option that would allow hospitals to receive partial reimbursement for some claim denials currently stuck in the...
Claims denials may be a part of life for healthcare revenue cycle managers, but a prevention-focused denials management strategy may be able to significantly reduce the number of times billing staff are faced with unpaid claims.
Recent...
CMS recently announced a new provider engagement initiative designed to improve the clinician experience within the Medicare program, especially as value-based care models are developed under the...
Claims denials typically represent one of the largest revenue cycle bottlenecks in most healthcare organizations. However, slowing down to determine why claims are being denied hasn’t...
As the transition to value-based care carries on, many healthcare providers are reexamining their current healthcare revenue cycles to account for new alternative payment models. With providers...
Let’s face it. Testing isn’t working. That’s the hard truth about the healthcare industry and its track record on claims accuracy testing and quality assurance.
The harder truth...
Revenue cycle management is the progression of events between when a patient makes a doctor’s appointment and when a patient’s money is received and reimbursed for following care...
