Claims Management

40% of Charges for COVID-19 Services Initially Ended in Claim Denials

by Jacqueline LaPointe

Providers are having a difficult time billing for services related to COVID-19, with 40 precent of charges for coronavirus-related care initially winding up as claim denials in the first 10 months of...

Prior Authorizations Beat COVID Workplace as Top Regulatory Burden

by Jacqueline LaPointe

Prior authorizations are troubling medical groups more than regulations governing the workplace during COVID-19 and Medicare’s Quality Payment Program, according to survey results from the...

AHA Calls for Medicare Advantage Inclusion in Prior Authorization Rule

by Victoria Bailey

The American Hospital Association (AHA) has asked CMS to include Medicare Advantage organizations in its proposed rule that would streamline the prior authorization process and reduce patient care...

HHS Removes 79% of Medicare Appeals Backlog, On Track for FY 2022

by Victoria Bailey

HHS has reduced the Medicare appeals backlog at the Administrative Judge Level by 79 percent, which puts the department on track to clear the backlog by the end of the 2022 fiscal year. As of June 30,...

Difference Between Clean Claims, Initial Claim Denials Key Hospital KPI

by Jacqueline LaPointe

The difference between clean claims and initial claims denials is a major key performance indicator (KPI) that hospitals track, according to a new survey. The new survey from healthcare revenue cycle...

Physician Practice Interruption Increased Due to COVID-19 Pandemic

by Victoria Bailey

Physician practice interruptions, like declining patient volumes and claims submitted, were abundant in 2020 compared to the previous year, likely due to the COVID-19 pandemic, according to research...

How Nebraska Medicine Turns Claims Data into Revenue Cycle Strategy

by Jacqueline LaPointe

Healthcare providers and payers send millions of business transactions a day. These transactions ensure providers get paid for delivering care to patients, but they also create a treasure trove of data...

Telehealth Claim Lines Stabilize After Months of Decline

by Jacqueline LaPointe

The percentage of telehealth claim lines has stabilized at about 5 percent of medical claim lines, indicating a new balance of virtual and in-person care. The analysis conducted by FAIR Health as part...

AMA Calls for Suspension of Prior Auths During PHEs, Better Peer Reviews

by Jacqueline LaPointe

Payers should temporarily suspend prior authorization requirements during public health emergencies (PHEs), according to a new policy from the American Medical Association (AMA). Physicians have faced...

Over Third of Hospital Execs Report Claim Denial Rates Nearing 10%

by Jill McKeon

Hospital claim denial rates are at an all-time high, signaling a need for better claims denial management, a recent survey from Harmony Healthcare reveals. The healthcare industry has seen a 20 percent...

Medicare Claims Data Show Health Disparities in COVID-19 Patients

by Jill McKeon

Researchers found significant disparities in Medicare fee-for-service beneficiary spending in an analysis of Medicare claims data relating to COVID-19, according to a Centers for Disease Control and...

CT Physicians Accused of “Price Gouging” COVID-19 Tests

by Jacqueline LaPointe

A group of physician practices in Connecticut suing Cigna over COVID-19 reimbursement is actually exploiting a national health emergency by overcharging for COVID-19 tests, the payer recently told a...

Coalition Urges CMS to Rethink Medicare Prior Authorization Growth

by Jacqueline LaPointe

A broad coalition of healthcare industry groups is calling on CMS to reconsider Medicare prior authorization growth among outpatient services set to go into effect this summer. The 40 groups...

Prior Authorization Burden Still High Despite COVID Struggles

by Jacqueline LaPointe

Most physicians still faced a high prior authorization burden despite treating a surge of positive COVID-19 cases this winter, the American Medical Association (AMA) reports. In a survey of 1,000...

OIG Asks Hospital for $23.6M Back After Medicare Billing Errors

by Jacqueline LaPointe

The Office of the Inspector General has identified $23.6 million in overpayments reimbursed to a Nevada-based hospital, resulting from years of Medicare billing errors. In a report released on April...

CMS Holding Claims Until Medicare Sequester Decision

by Jacqueline LaPointe

UPDATED 04/16/2021 CMS is temporarily holding claims from providers in anticipation of legislation that will extend the suspension of the 2 percent Medicare sequester, according to a recent...

RCM Automation Boosts Practice’s Accounts Receivable Efficiency

by Jacqueline LaPointe

Days in accounts receivable (A/R) is one of the most important key performance indicators for growing practices. In an increasingly complex healthcare environment—and one in which financial...