Do Payers Use Utilization Management to Their Advantage to Deny Claims?

Utilization management is a review process used to evaluate the medical necessity and appropriateness of healthcare treatments and procedures ordered. What happens when patients are being denied access to essential treatment through this met

Utilization management is a review process used to evaluate the medical necessity and appropriateness of healthcare treatments and procedures ordered. What happens when patients are…

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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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