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

Claims Processing

Medicare Appeals Backlog Delays Decision Process By 4.5 Years

May 11, 2017 - 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. Researchers from Johns Hopkins Hospital, University of Wisconsin Hospitals and Clinics, and University of Utah analyzed all complex Part A appeals between...


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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...

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...

Using Data Analytics to Decrease Claims Denials, Boost Revenue

by Jeff Wood

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 traditionally been an option. The light at the...

Why Claims Accuracy Testing, QA Isn’t Working for Healthcare

by Mark Benedict

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 is that this problem is expensive –...

5 Claims Denials Management Conversations From 2015

by Jacqueline DiChiara

This year, the healthcare industry lived in denial. Claims denial, that is. Claims denials management dialogues were extensive and recurring among healthcare providers across the industry this year.  Here are 5 claims denials management...

Safeguards possibly ineffective on some copayment coupons

by Elizabeth Snell

Pharmaceutical manufacturers’ current safeguards may not prevent all copayment coupons from being used for drugs paid for by Part D, according to a recent Office of Inspector General (OIG) report. The coupons are typically offered to reduce...

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