Claims Management

Organizing. Billing. Updating. Filing. Hospital claims management is a broad term that encompasses all of medical claims billing processes and hospital payment models. Learn more about medical billing, denial management process, and more in our collection of articles here.


Hospital Revenue Cycle Teams Feel Financial Pain

As regulations change and the ACA is weakened, hospitals face a new round of revenue challenges centering on a patient’s ability to pay. We take a look at the pain points teams face, trends, and solutions.

Rising Healthcare Costs Impact Patients and Providers

Financial perils in the healthcare industry continue. Costs rise. Deductibles increase. Hospital debt forces closures. The impact of soaring health costs reaches everyone involved, from the providers of healthcare to the patients.

Healthcare Claim Denials on the Rise

Why do payers continue to deny 20% of claims payments to hospitals as they struggle to keep revenue cycles more profitable? Baby boomers are moving into their Medicare coverage phase. There are flaws in the Office of the Inspector General audits of hospitals, as alleged by the American Hospital Association.  Regulations are increasing. We take a look at the current situation and some creative solutions

Hospital Billing Best Practices

When it comes to hospital billing best practices, we discovered a lot of documentation about common errors and also some helpful advice on how to avoid them.

Insurers Denying Unnecessary Emergency Room Visits

Just how many unnecessary emergency room visits are there and are major insurers making the right call in denying claims for visits deemed unnecessary? According to the American College of Emergency Physicians (ACEP), they’re wrong.

Improving Hospital Claims Denials Management

What can hospitals do to improve their claims denials management process? We review some facts about claims denials, and share valuable advice as to how hospitals should address the issue head-on.

Improving Hospital Claim Collection Rates

Regarding claims management, the holy grail for hospitals continues to be a high clean claim rate… but how do you get there?  What KPIs — Key Performance Indicators — does your revenue cycle team follow?  Is the clinical side dialed into the process?  We take a look at some recommendations in this article.

Healthcare Payers and Providers Collaborate to Improve Outcomes

Value-based incentives and other policies of recent years have forced healthcare payers and providers to work together more closely and communicate more often. Such policies include aspects such as risk-sharing financial arrangements and programs aimed at improving the patient experience. Join us as we explore the dynamics of this relationship that can improve profitability. 

How Hospital Billing and Claims Management Processes Affect Revenue

Hospital billing and claims management processes have a clear and direct impact on the financial health of an organization. However, oftentimes healthcare executives blame poor performance on external factors, rather than analyzing internally. We take a deeper look at this issue and how hospitals can improve their practices to increase revenue. 

Hospital Claims Denial Management Solutions

Denial and claims management are key focus areas in the hospital revenue cycle process.  While traditionally thought of as a back-end focus area, more hospitals are taking a proactive approach to identifying possible problems up front.