Category: Claims & Contract Management

  • How to keep up with changing payer requirements

    The payer policy rollercoaster has taken a few twists and turns recently, leaving healthcare organizations out of the loop if they try to keep pace with payer requirements using manual systems alone. Keeping track of changing payer requirements has long been a major challenge for providers, but several shifts in the reimbursement landscape have prompted […]

  • Better claims management: faster patient payments & reduced denials

    Navigating an increasingly complex reimbursement landscape remains challenging for today’s healthcare providers, with too many claims still underpaid, delayed or outright denied. In fact, nearly 70% of providers said the problem of denied claims had worsened during 2021. Naturally, relationships with payers suffer, adding friction to the process. To this end, revenue cycle leaders are […]

  • How to prepare for CMS’s Appropriate Use Criteria Program

    The Appropriate Use Criteria (AUC) program is due to come into full effect in January 2023 at the earliest. The program was established by the Centers for Medicare and Medicaid Services (CMS) to help providers order the most appropriate diagnostic imaging services. Failure to comply may result in claims denials. Any provider that offers these […]

  • Reducing claims denials to get paid faster

    Claims denials are a major source of headaches for healthcare organizations. On average, denied claims can take more than two weeks longer to pay out than first-time claims, if they get paid at all. Denials can have major downstream impacts, including lower annual net revenue, additional hours spent on administrative work, and potential disruptions to […]

  • 3 data-driven denial management strategies for faster claims processing

    In the sixth article in our series on how the patient journey has evolved since the onset of COVID-19, we look at three ways to prevent claim denials and reduce the time to payment. Faster claims processing is at the heart of a better patient financial experience and reduces revenue leakage for providers. For more […]

  • Navigating the complexities of health coverage and reimbursement beyond the pandemic

    Product featured in this article: Coverage Discovery As of the end of March 2021, more than 53 million Americans have been fully vaccinated, allowing for cautious optimism as we prepare for the next phase of the COVID-19 journey. Unfortunately for pharmacists, the vaccination program has compounded many of the challenges of the last 12 months. […]

  • Q&A: Optimize reimbursements by submitting cleaner claims

    Many thought the end of COVID-19 was in sight with the availability of a vaccine, and while that is somewhat true, an entirely new set of issues has arrived: how to properly administer and manage the vaccine. Now that a COVID-19 vaccine is approved and underway, providers need to execute a medical billing and coding […]

  • What is Revenue Cycle Management?

    There is no question that providers’ bottom line has been hit hard this year, and a new surge in COVID-19 is bound to threaten hospital finances once again. As healthcare providers look to supercharge their payment velocity during these uncertain times, it’s worth taking a step back to examine the revenue cycle management process as […]

  • Five ways to reduce claim denials

    Claims denials put a big dent into the budgets of healthcare providers – something many organizations can’t afford today given the current pandemic. In an environment where everyone must do more with less, reducing claim denials could release vital revenue and staff time to create breathing space for quality improvement. The good news? About 90% […]

  • The challenges and risks associated with patient identity

    Halloween is just around the corner, and while the holiday and celebration may look a little different this year (no thanks to COVID-19), the excitement over costumes and dressing up will likely remain the same. When it comes to patient identity, however, costumes and disguises aren’t so exciting. And unfortunately, the challenges and risks associated […]

  • Technology key for hospital financial recovery following COVID-19

    Financial recovery after COVID-19 is likely to be a slow burn for most healthcare organizations, according to a recent survey. Nearly 90% of healthcare executives expect revenue to drop below pre-pandemic levels by the end of 2020, with one in five anticipating a hit greater than 30%. While the return of elective procedures will be […]

  • 4 Tips for Launching Telehealth Services

    With COVID-19 leading to postponed and cancelled medical appointments, more consumers are turning to “contactless care”. Recent figures suggest telehealth adoption has shot up from just 11% in 2019 to 46% over the course of the pandemic, and some providers are seeing up to 175 times the number of telehealth patients than pre-COVID. As they […]

  • Telehealth Benefits Expansion: Helping Providers Maximize Reimbursement

    Patients today expect digital capabilities from their provider and will increasingly choose those who offer digital capabilities. Knowing this, many providers have been working to shift more of the patient journey online, through telehealth and virtual care. Not all care needs to be delivered face to face, and technological advances allow patients to access more […]

  • Medicare MBI: COVID-19 and Medicare Claims

    At the beginning of the year, the healthcare industry moved away from Medicare identifiers based on Social Security Numbers (SSNs), in favor of more secure Medicare Beneficiary Identifiers (MBIs). As with any large-scale change program, the shift was unlikely to be completely clear sailing. But with the coronavirus pandemic landing shortly after the 21-month transition […]

  • How to avoid patient misidentification and claims denials amidst COVID-19

    For many of the 36 million Americans who have registered for unemployment benefits during the coronavirus outbreak, losing their job means losing their health insurance. Options for the newly-unemployed are limited yet complicated: while the federal government has declined to reopen enrollment under the Affordable Care Act, several states are supporting those without coverage by […]

  • How automating charity care eligibility improves the patient financial experience

    There’s a phenomenon in online product reviews where the customer seems to love their purchase, yet gives it only one or two stars. Why do they do this? Poor customer service: the item was delivered late, questions went unanswered, or payment processing was disorganized. When the consumer experience falls below expectations, the brand suffers – […]