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, […]
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 […]