Navigating False Credits: Unveiling Causes and Solutions
The top 5 causes for false credit balances and what to do about them. False credit balances in healthcare accounts receivable are more than just numerical errors; they symbolize a daunting challenge that disrupts financial accuracy and operational efficiency. In a world where precision is paramount, these inaccuracies cast shadows of doubt, consuming valuable resources, […]
Looking Back: A 2023 Retrospective of Denial Industry Trends
As we look back on 2023, it’s evident that the denial industry has experienced a significant increase in claim denials. Nearly half of providers indicated that they saw a rise in denials compared to 2022. Advent Health Partner’s data supports this by indicating an increase of 30% more denied dollars, year over year, on a […]
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 […]
Utilization Management to Increase Patient Satisfaction
What is a health system without patients, or patients without a health system? Patient satisfaction is overwhelmingly important to the growth and success of a health system, and in turn, they expect the utmost care. That doesn’t mean the system is without its complications. Utilization management is designed to increase patient satisfaction while improving a […]
Optimizing Your Revenue Cycle: Best Practices & Recommendations
What is Utilization Management? Utilization Management assures your patients receive the care they need and provides a base to start focusing on denial prevention. Utilization Management comprises three assessments: prior authorization, pre-bill reviews, and concurrent reviews. Prior Authorization: Also known as prospective reviews, prior authorization decreases denials and increases patient access by requiring approval before […]
Optimizing Your Revenue Cycle: Strategic Partnerships
More than one-third of nurses plan to leave their positions by the end of 2022, prolonging the nursing shortage. In addition to nurses, there is a strong trend of struggling to retain revenue cycle staff. Approximately 25 percent of healthcare finance leaders report that their revenue cycle team is short by approximately 20 people. Finding […]
Optimizing Your Revenue Cycle: Applying Analytics
Following and understanding industry trends is one of the best ways to improve your revenue cycle. By nature, the healthcare industry is constantly evolving. This means that your revenue strategy won’t stand up to the test of time without optimization and development. The best revenue plan is strict, flexible, and keeps up with industry trends. […]
Optimizing Your Revenue Cycle: Denial Prevention
As of 2022, payer denial rates are hitting averages as high as 80%. This increase in denials severely affects hospitals by decreasing revenue and overloading staff. Why the increase in denial rates, though? Payers are rapidly gaining two things: knowledge and technology. Their algorithms are getting smarter, which drives up productivity without having to increase […]
Optimizing Your Revenue Cycle: Clean Claim Rate
An efficient denial prevention process is based on the concept of clean claims. Your clean claim rate is the differentiating factor between denial prevention and appeal management. Ensuring clean claims is critical to your bottom line. Why? Clean claims are 1:1, dollar for dollar, every time. The farther a claim is in the denial process, […]
The Best Way To Optimize Your EMR
Providers today are better informed and are prepared to take on more challenges due to the information and flexibility that EMRs provide, yet this technological tool is not without its downfalls. EMRs are notoriously hard to navigate, especially when performing manual reviews. Being a strong source of information is detrimental when people have to manually […]