Strategic Escalation in the Face of Rising MA Plan Denials Originally published on Becker's Hosptal ReviewRelationships between providers and Medicare Advantage (MA) plans have become more strained as payers aggressively deny claims. To ensure providers' financial...
From Cost Cuts to Revenue Gains: How Hospitals Can Turn Financial Pressures into Opportunities Originally Published on Becker's HealthcareImagine losing millions of dollars in potential revenue simply because of a classification error. For hospitals grappling with...
How Hospitals Can Mitigate Financial, Legal, and Compliance Risks By Geoff New Inadequate clinical documentation can lead to serious consequences.  Historically, poor documentation has resulted in significant financial losses through penalties, damaged...
Inside AI-Driven Medical Coding Exploring AI and ML Technologies in Healthcare Workforce shortages, regulatory complexities, and economic challenges have put hospitals and health systems under immense pressure to improve operational efficiency, accelerate payments,...
The Limitations of CMI as a KPI by Sam Dominik, Senior Vice PresidentTraditional hospital performance metrics like denial rates, CMI, LOS, and readmission rates hinder progress. It’s time to shift your perspective on KPIs.  Traditionally, a higher CMI indicates a...
'We need everybody to work together': As denials grow, health systems are responding with strategic, data-driven approaches Originally Published on Becker's HealthcareThe nation's largest payers reported billions in profits in 2023. Yet, denials continue to rise. ...
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Five hospital outpatient department (OPD) services will require prior authorization when provided on or after July 1, 2020. These services include: Blepharoplasty Botulinum toxin injections Panniculectomy Rhinoplasty Vein ablation What is prior authorization as it...
The U.S. Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) issued separate announcements last week that I think will interest you. HHS Updates HHS announced two additional distributions from the Coronavirus Aid,...
The $2 trillion Coronavirus Aid, Relief, and Economic Security (CARES) Act includes more than $100 billion in aid in a Provider Relief Fund for healthcare organizations. In recent weeks, the Department of Health and Human Services (HHS) has issued guidelines on how...
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