Uncover the Hidden Potential of In-House Clinical Appeals
Over half of U.S. hospitals ended 2022 with a negative margin as increased expenses quickly surpassed revenue growth. Among the issues heavily affecting the industry are claim denials—they have emerged as one of the most critical financial challenges for healthcare providers to manage, ultimately impacting the financial well-being of both healthcare providers and patients. Denied […]
Improving Hospital Denials by Department
A hospital’s denial issues vary based on the organization, and because of this, sometimes pinpointing potential denials can be difficult. Moving from a management to a prevention model is a slow process, and issues can potentially arise if denials by the department are overlooked. However, the point of denial prevention is to move towards a […]
First Steps for a Denial Prevention Framework
According to U.S. Healthcare Denial Management Market, a study conducted by Research and Markets, in 2021, the U.S. healthcare denial management market size was valued at $3.57 billion. By 2027 it’s expected to grow an additional 66% and reach $5.94 billion. Denial management can leave millions, if not billions, of dollars on the table if […]
Shifting the Focus from Denial Management to Denial Prevention
As the volume of denials continues to increase, hospitals and health systems need a more proactive approach to denial management and prevention. Providers are encouraged to move from a denial management framework to a denial prevention framework to capture appropriate reimbursement. This will decrease time to revenue by shifting from management and appeals into data, […]
Proper Reimbursement Payer Policies [Webinar]
When aiming to ensure proper reimbursement for your hospital or health system, many variables are involved to continually refine payer policies to individual chargemasters. In this webinar recorded in partnership with HFMA Region 9, Deborah Horne, Advent Health Partners’ Vice President of Clinical Operations, discusses the current challenges in receiving reimbursement. She walks through a case […]
Effective Medical Necessity & Clinical Reviews Amid the Nursing Shortage
The US is currently experiencing a significant nursing shortage, and it unfortunately isn’t expected to end anytime soon. Since the start of the COVID-19 pandemic, our country’s nurses have demonstrated their dedication and heroism, highlighted in countless news stories and social media movements. Nurses are critical to our healthcare system and comprise the most extensive […]
Staff Reallocation Amid a Staffing Crisis
Registered nurses perform several jobs throughout a hospital system, most commonly patient care and coding/billing procedures. So, when a hospital starts losing its nursing staff, several critical departments start lacking needed attention. Hospitals are more likely to reallocate their remaining nurses to patient care instead of denial management because patient satisfaction is one of the […]
Understanding the Cost of Nurse Turnover
Hospitals and their nurses are still feeling the shockwave effects from the height of the COVID pandemic, specifically the increased nurse turnover rate. In 2020 and 2021, many nurses retired or left the profession to pursue different careers, and the nation was left with an influx of COVID patients and a shortage of nurses. Other […]
Pre-bill Review Advantages for your Denial Management System
The Rise of Denials According to Fierce Healthcare, hospital denial rates were climbing prior to the COVID-19 pandemic, but they reached new heights as hospitals had to counter the new public health emergency. Harmony Healthcare conducted a study and received responses from 130 respondents. One-third of hospitals who responded to their poll said their hospitals […]
Six Common Claim Denial Causes for Hospitals
Medical Billing Reform Since 2008, the American Medical Association (AMA) has taken the lead to bring reform to the medical billing and payment system. Even amidst the COVID-19 pandemic, the AMA played a crucial role in shaping the federal response to the omnibus legislative package in December 2020. While healthcare organizations may still end up with a denial […]