Improving Hospital Denials by Department

Doctors wheeling a patient in a bed down a hallway at a hospital.

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 department are overlooked. However, the point of denial prevention is to move towards a denial-free […]

First Steps for a Denial Prevention Framework

Coins stacked in front of an upward trending graph.

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

denial prevention framework

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, […]

Effective Medical Necessity & Clinical Reviews Amid the Nursing Shortage

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 […]

Pre-bill Review Advantages for your Denial Management System

Hospital woman reviewing documents

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 […]

Preventing Denials: Root Cause Analysis

Preventing Denials: Root Cause Analysis

The Importance of Root Cause Analysis Root cause analysis is an instrumental part of any revenue integrity program as it aims to prevent denials before they ever happen. Getting down to the root cause of the issue is an—almost—surefire way to avoid the initial denial. Knowing your organization’s specific root causes will allow for faster, […]

3 Things to Look for in a Revenue Integrity Partner

A doctor in a white doctor's coat is shaking the hand of someone wearing a blue shirt. Another doctor is standing in the back holding a clipboard and smiling.

A revenue integrity partner is necessary for building a broader understanding of organizational claims processes and improvement opportunities. A strategic partner can help decrease time to revenue and reduce administrative costs. Finding and onboarding a partner for your revenue integrity program involve both time and resources, making it important to find the right fit from […]

The Importance of Client Success in Your Revenue Integrity Partner

A group of nurses and doctors in a sunlit corridor high-fiving each other.

Hospitals and health systems seek partnerships that provide solutions to improve revenue integrity. A partner that fosters client success is essential and allows you to manage your revenue cycle more effectively, creating a decreased time-to-money ratio. A sense of urgency, root cause analysis, subject matter expertise, open and consistent communication, and frequent reporting are all […]

The Importance of Technology Solutions From Your Revenue Integrity Partner

A doctor holding a tablet. Various medical symbols are displayed floating in the image.

One of the most important elements in a revenue integrity partnership is technology. When considering engaging a revenue integrity partner or optimizing your current strategy, a commitment to technology will be an asset to the revenue integrity management teams.  Healthcare has changed dramatically, even in the last decade, with greater access to technology. Technology enables […]

The Importance of Clinical Expertise in A Revenue Integrity Partner

Defocused shot of a group of medical practitioners working in a hospital.

When considering engaging a revenue integrity partner, it’s essential to focus on three main components: clinical expertise, the right technology, and proven client success, but for this article, we will focus on clinical expertise. Clinical expertise is critical in solving clinical and coding review challenges. Some important qualifications include:  Having a team of industry veteran […]