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

Claims Management

Hospitals Wait 16 More Days for Late Payments from Claim Denials

by Jacqueline LaPointe

Delayed payments stemming from claim denials are significantly impacting hospital revenue cycles, taking an average 16.4 more days to pay compared to claims that have not been denied, a new analysis from Crowe Horwath revealed. The...

Medical Billing Complexity Highest for Medicaid Fee-for-Service

by Jacqueline LaPointe

Medical billing for Medicaid fee-for-service claims proved to be the most complex across all insurers. The public payer had a claims denial rate 17.8 percentage points greater than the rate for Medicare fee-for-service claims, a new Health...

Bringing Profee, Facility Together to Maximize Coding Productivity

by Jacqueline LaPointe

Professional and facility coding describe two very different aspects of a healthcare. But breaking down the wall between the departments has the potential to boost coding productivity and improve clean claim rates. While professional...

92% of Docs Say Prior Authorizations Negatively Impact Outcomes

by Jacqueline LaPointe

Physicians are reporting that prior authorizations are negatively affecting patient care, a new American Medical Association (AMA) survey of 1,000 physicians showed. Ninety-two percent of primary care and specialty physicians who provide...

CMS Guidance to Lower Claim Denials for Inpatient Rehab Facilities

by Jacqueline LaPointe

CMS recently clarified that contracted auditors should not give inpatient rehabilitation facilities claim denials solely because the services did not meet time-based therapy requirements. The guidance, which will go into effect on March...

AMA, Anthem Team Up to Streamline Prior Authorizations

by Jacqueline LaPointe

The American Medical Association (AMA) and Anthem, Inc. recently announced that they will work together over the next year to streamline prior authorization requirements and improve the healthcare experience overall through provider and...

CMS Opens Low Volume Appeals Settlement to Reduce Appeals Backlog

by Jacqueline LaPointe

In the face of a growing Medicare appeals backlog, CMS opened the first round of a low volume appeals settlement on Feb. 5 for providers with less than 500 claim denial appeals stuck in the appeals backlog at the Office of Medicare...

AHA, AMA and Others Offer 5 Prior Authorization Reform Strategies

by Jacqueline LaPointe

Six industry groups representing providers, payers, and pharmacists recently partnered to identify strategies to improve prior authorization processes, such as decreasing the number of providers subject to prior authorizations and...

CAQH CORE Opens Certification for Electronic Prior Authorization

by Jacqueline LaPointe

CAQH’s Committee on Operating Rules for Information Exchange (CAQH CORE) recently opened the certification process for Phase IV operating rules, which include standard rules for the electronic exchange of administrative data, such as...

Private Payer A/R, Denials Performance Troubles Hospital Revenue

by Jacqueline LaPointe

Small differences in private payer performance on claims reimbursement and denials can challenge hospital revenue cycles, a new Crowe Horwath analysis of five major commercial managed care payers uncovered. “Many providers focus...

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

by Jacqueline LaPointe

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...

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

by Jacqueline LaPointe

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...

AHA: OIG Hospital Audit Extrapolation Led to Excessive Claim Denials

by Jacqueline LaPointe

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...

EFT Flaws, Paper Enrollment Key Electronic Claims Management Issues

by Jacqueline LaPointe

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...

HHS Offers Special Medicare Reimbursement After Hurricane Irma

by Jacqueline LaPointe

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...

17% of Practices Pay Fees for Electronic Healthcare Payments

by Jacqueline LaPointe

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...

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

by Jacqueline LaPointe

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...

Court to Reconsider Timeline for Medicare Appeals Backlog End

by Jacqueline LaPointe

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...

Medicaid Reimbursement Woes Key Concern for Healthcare CEOs

by Jacqueline LaPointe

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...

Proactive Healthcare Charge Integrity Captures Missed Revenue

by Jacqueline LaPointe

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...

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