Trends in Denial Management for 2021

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While medical necessity remained the number one type of denials in 2021, our team has seen three additional causes emerge as significant sources of denials this year. If your hospital or health system is experiencing any of these denials, know that there are answers and ways to prevent them from occurring in the future. 1. […]

[VIDEO] Clinical Expertise Overview

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A Strategic Partner With Clinical Expertise At Advent Health Partners, we consider ourselves a strategic partner that works as an extension of your team to provide client-specific appeal expertise, real-time reporting, and knowledgeable recommendations. What makes us unique is the diverse clinical expertise that makes us successful as subject matter experts: 95% of our nurses […]

3 Considerations for Denial Avoidance

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Imagine a scenario where a patient needs a necessary surgery like a prostatectomy due to prostate cancer. When the provider and patient decide to move forward with the surgery, it’s essential to set a precedent by talking to both the patient and the insurance company to find out what the out-of-pocket costs will be. By […]

5 Tips for Healthcare Providers to Better Prevent DRG Downgrades

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The clinical downgrading of diagnosis-related groups (DRG), or DRG downgrades, has become an extremely problematic issue for healthcare providers over the past decade. Overall, denials related to DRGs are increasing; downgrading target DRGs without even requesting documentation can also happen. One healthcare system, for example, found that DRG downgrades have increased from an average of […]