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.

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…

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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.

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…

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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. 

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 …

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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 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…

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Healthcare Payers Uncertainty Lingers Following Demise of AHCA

How are healthcare payers affected by the demise of the recent Republican healthcare bill? Let’s review how payers are impacted by this and other legislative changes, and the reemergence of talk about a single-payer healthcare system.

How are healthcare payers affected by the demise of the recent Republican healthcare bill? Let’s review how payers are impacted by this and other legislative changes, and the reemergence of talk about a single-payer healthcare system….

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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.

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Claims Denial Management Evolution

Claims denial management tools are continuing to evolve with good records for positive impact on the hospital revenue cycle process. Why then are so few hospitals implementing these solutions?