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

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.

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

utilization management

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

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, […]

Proper Reimbursement Payer Policies [Webinar]

Proper Reimbursement

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

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 […]