The Best Way To Maximize Your EMR

A doctor filling out a patient medical record.

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 […]

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 […]

4 Ways to Prevent Disallowed Charges From Bundled Claims

Prevent Disallowed Charges

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

3 Things to Look for Revenue Integrity Partner FI

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

Revenue Integrity Partner Client Success

Hospitals and health systems seek partnerships that provide solutions to improve revenue integrity, and 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 expert, open and consistent communication, and frequent reporting are […]

The Importance of Technology Solutions From Your Revenue Integrity Partner

Revenue Integrity Partner Technology

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 […]