Effective Medical Necessity & Clinical Reviews Amid the 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 […]
Staff Reallocation Amid a Staffing Crisis
Registered nurses perform several jobs throughout a hospital system, most commonly patient care and coding/billing procedures. So, when a hospital starts losing its nursing staff, several critical departments start lacking needed attention. Hospitals are more likely to reallocate their remaining nurses to patient care instead of denial management because patient satisfaction is one of the […]
Understanding the Cost of Nurse Turnover
Hospitals and their nurses are still feeling the shockwave effects from the height of the COVID pandemic, specifically the increased nurse turnover rate. In 2020 and 2021, many nurses retired or left the profession to pursue different careers, and the nation was left with an influx of COVID patients and a shortage of nurses. Other […]
Pre-bill Review Advantages for your Denial Management System
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 […]
Six Common Claim Denial Causes for Hospitals
Medical Billing Reform Since 2008, the American Medical Association (AMA) has taken the lead to bring reform to the medical billing and payment system. Even amidst the COVID-19 pandemic, the AMA played a crucial role in shaping the federal response to the omnibus legislative package in December 2020. While healthcare organizations may still end up with a denial […]
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, […]
91+% Denial Overturn Rate
How We Achieve Our 91+% Denial Overturn Rate In this 1-minute video, you will discover tips on our strategic appeal process for achieving a 91+% denial overturn rate. With this insight and leveraging clinical and payer expertise, you could enhance your overturn rate to ensure maximum appropriate reimbursement from the payer.
US Staffing Crisis: Nurses in High Demand
Across the US, nursing shortages are close to reaching a critical level. A McKinsey survey from May 2021 reported that 22% of the nurse respondents suggested they were considering leaving their current positions driven by factors that have developed during the pandemic. To make a bad scenario even worse, over half of these nurses are […]
4 Ways to Prevent Disallowed Charges From Bundled Claims
For the past few years, Medicare has been testing out new ways to bundle claims. The goal of this bundled claim switch is to improve care and reduce costs. A few apparent benefits in the bundled claims model have already been tested. One is simplifying the billing process by instituting a single price for all […]
3 Things to Look for in a Revenue Integrity Partner
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 […]