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Versalus Health Comments on the April 2022, Office of Inspector General Report on “Some Medicare Advantage Organization Denials of Prior Authorization Requests Raise Concerns About Beneficiary Access to Medically Necessary Care” Summary: The Center for Medicare and...
CMS Issues Update to the Medicare Claims Processing Manual Chapter 30 Section 200: Financial Liability Protections Overview On January 21, 2022, CMS released a Medicare Learning Matters (MLN) announcing a change request (CR 12546), resulting in substantial edits to...
Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Final Rule Overview On November 2, 2021, CMS released the anticipated CY 2022 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center...
By Jerilyn Morrissey, MD Regardless of who your team reports to on the organization chart, there is no getting around the fact that Utilization Management (UM) is part of the clinical revenue cycle of your organization. Embracing that concept may challenge your...
Let’s talk about denials, a frequent and often unpleasant topic in Utilization Management (UM). One of the core beliefs of most UM teams is that denials are bad, and most of UM teams’ efforts are spent trying to prevent or reduce denials. You may have even purchased...
Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Proposed Rule Overview On July 19, 2021, CMS released the anticipated CY 2022 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical...
DALLAS—July 20, 2021 — CorroHealth has acquired Medical Savant after a successful year-long pilot of fully autonomous coding and charge capture. Automation exceeding 95% of encounters proved the benefits of combining Medical Savant Autonomous Coding with the CorroHealth Advanced Coding Solution (ACS).
There is still a lot of confusion regarding the impact on Medicare beneficiaries from eliminating the Inpatient-Only List. As recent as last week, an article from The Washington Post titled New cost-cutting Medicare rule may add costs to patients, discussed how this...
BFCC-QIO National Claim Review Contract Awarded for Short Stay and Higher-Weighted Diagnosis Related Group (HWDRG) Claims Overview Livanta, a Centers for Medicare & Medicaid Services’ (CMS) Beneficiary and Family Centered Care – Quality Improvement Organization...
By Joseph Zebrowitz, MD Denials Are Bad…Maybe Not One of the central tenets of utilization management is that “denials are bad.” Our hospitals have developed a myriad of Key Performance Indicators (KPIs) that reflect this: we track denial rate and total number of...
Versalus Health Comments on the April 2022, Office of Inspector General Report on “Some Medicare Advantage Organization Denials of Prior Authorization Requests Raise Concerns About Beneficiary Access to Medically Necessary Care” Summary: The Center for Medicare and...
CMS Issues Update to the Medicare Claims Processing Manual Chapter 30 Section 200: Financial Liability Protections Overview On January 21, 2022, CMS released a Medicare Learning Matters (MLN) announcing a change request (CR 12546), resulting in substantial edits to...
Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Final Rule Overview On November 2, 2021, CMS released the anticipated CY 2022 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center...
By Jerilyn Morrissey, MD Regardless of who your team reports to on the organization chart, there is no getting around the fact that Utilization Management (UM) is part of the clinical revenue cycle of your organization. Embracing that concept may challenge your...
Let’s talk about denials, a frequent and often unpleasant topic in Utilization Management (UM). One of the core beliefs of most UM teams is that denials are bad, and most of UM teams’ efforts are spent trying to prevent or reduce denials. You may have even purchased...
Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Proposed Rule Overview On July 19, 2021, CMS released the anticipated CY 2022 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical...
DALLAS—July 20, 2021 — CorroHealth has acquired Medical Savant after a successful year-long pilot of fully autonomous coding and charge capture. Automation exceeding 95% of encounters proved the benefits of combining Medical Savant Autonomous Coding with the CorroHealth Advanced Coding Solution (ACS).
There is still a lot of confusion regarding the impact on Medicare beneficiaries from eliminating the Inpatient-Only List. As recent as last week, an article from The Washington Post titled New cost-cutting Medicare rule may add costs to patients, discussed how this...
BFCC-QIO National Claim Review Contract Awarded for Short Stay and Higher-Weighted Diagnosis Related Group (HWDRG) Claims Overview Livanta, a Centers for Medicare & Medicaid Services’ (CMS) Beneficiary and Family Centered Care – Quality Improvement Organization...
By Joseph Zebrowitz, MD Denials Are Bad…Maybe Not One of the central tenets of utilization management is that “denials are bad.” Our hospitals have developed a myriad of Key Performance Indicators (KPIs) that reflect this: we track denial rate and total number of...
Addressing the Rising Challenge of Bad Debt in Healthcare FinanceRising bad debt and charity care have emerged as a defining financial challenge for U.S. hospitals. What initially seemed like a temporary disruption has evolved into a sustained trend, prompting finance...
Hospitals today face mounting financial pressure, yet many leaders still lack a clear view of what strong performance truly looks like. Revenue shortfalls are often attributed to payer denials or market forces outside an organization’s control. Performance gaps...
Uncovering the Impact of DRG Downgrades and Post-Pay Audits on Hospital MarginsDiagnosis-related group (DRG) downgrades are surging as one of the top payer denials tactics, increasing nearly 57% between 2022 and 2023. No longer just occasional frustrations, these...
