Denial Management

Hospital financial performance off to a strong start

March 28, 2024 - Hospital financial performance has stayed strong through the beginning of the year, according to the latest data from healthcare consulting firm Kaufman Hall. The latest “National Hospital Flash Report” showed a median monthly operating index, as determined by Kaufman Hall, of 3.96% in February 2024. The index was slightly below...


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Private payers initially deny nearly 15% of medical claims

by Jacqueline LaPointe

It may take some time to get paid for medical services, suggests a new survey of hospitals, health systems and post-acute care providers. Nearly 15 percent of medical claims submitted to private...

Lower reimbursement rates, denials behind razor-thin margins

by Jacqueline LaPointe

Hospitals and health systems are operating on razor-thin margins as reimbursement rates and denials create financial woes, a new survey indicates. The survey conducted by the Healthcare Financial...

Breaking Down the Back-End Revenue Cycle, Key Best Practices

by Jacqueline LaPointe

The healthcare revenue cycle is a continuous process that relies on each step to keep revenue flowing. However, many organizations break down the revenue cycle into front- and back-end steps to manage what happens before and after a...

Highlighting Top Revenue Cycle Management Vendors By User Review

by Editorial Staff

Epic, Experian Health, and Waystar are just some of the revenue cycle management vendors performing well across various operations. The 2024 Best in KLAS Software & Services report highlights the top vendors in claims management,...

Survey Reveals Revenue Cycle Management Concerns for 2024

by Victoria Bailey

When it comes to revenue cycle management, healthcare leaders are concerned about timely patient collections, managing denials, and hiring and training staff in 2024, new data found. The survey,...

Medicare Advantage Denials Jump 56%, Commercial Denials 20%

by Jacqueline LaPointe

Hospitals and health systems have seen a significant spike in claim denials as Medicare Advantage and commercial payers deny more of their reimbursement. A new analysis of data from over 1,300...

Patient Access, Registration Errors Lead to Most Claim Denials

by Jacqueline LaPointe

Hospitals and health systems are facing more claim denials as front-end revenue cycle processes lead to errors. A recent survey conducted by the Healthcare Financial Management Association’s...

Generative AI’s Potential Shines on Revenue Cycle Management

by Jacqueline LaPointe

Healthcare has its eyes on generative artificial intelligence (AI). The technology, including the popular ChatGPT tool, has passed medical exams, diagnosed complex cases, and designed new ways to combat COVID-19. However, its most...

62% of Hospitals Don’t Automate Any Part of Denials Management

by Jacqueline LaPointe

Most hospitals and health systems are not automating any component of denials management, according to a recent survey of healthcare finance and revenue cycle leaders. Commissioned by technology...

Claims Reimbursement Speed, Denial Rate Tied to Location

by Jacqueline LaPointe

Does your practice experience claims reimbursement delays? That may be because of where your practice operates, according to a recent analysis of financial transaction data. The new Crowe report,...

Claim Denials Pose Expensive Problem for Providers

by Jacqueline LaPointe

Claim denials are posing a serious and expensive problem for healthcare revenue cycle management (RCM), according to a recent survey of healthcare leaders. A survey conducted by Plutus Health...

Denial Management Calls for More Expertise, Survey Says

by Jacqueline LaPointe

Paging subject matter experts for denial management. According to a recent survey from healthcare AI vendor AKASA and the Healthcare Financial Management Association (HFMA), denial management requires...

Provider Groups Band Together to End Cigna’s Modifier 25 Policy

by Jacqueline LaPointe

The American Medical Association (AMA) and more than 100 other provider trade associations have taken issue with a new policy from The Cigna Group regarding claims with modifier 25. Cigna recently...

Revenue Cycle Leaders Spend the Most Time on Denials Management

by Victoria Bailey

Denials management and prior authorization are the most time-consuming revenue cycle management tasks for healthcare financial leaders, a survey commissioned by the healthcare operations company AKASA...

3 Trends from the Revenue Cycle Management Virtual Summit

by Jacqueline LaPointe

Patient financial experience, denial prevention, and remote work are major challenges for healthcare organizations, according to healthcare leaders at this year’s Revenue Cycle Management Virtual Summit. The Summit took place on...

Claim Denial Rates as High as 80% for Some Marketplace Payers

by Jacqueline LaPointe

Claim denial rates varied significantly among Healthcare.gov marketplace payers, with some insurers racking up rates as high as 80 percent, according to a new analysis from Kaiser Family...

HHS Reduced Medicare Appeals Backlog by 88% During FY 2022 Q1

by Victoria Bailey

HHS ended the first quarter of fiscal year 2022 by reducing nearly 88 percent of the Medicare appeals backlog at the Administrative Law Judge level. According to the Department’s status report...