All our latest thinking on medical billing, medical coding, accounts receivable and denial management processes, robotic process automation, artificial intelligence, machine learning and more..
The US healthcare industry utilizes Prior Authorization as a means of ensuring optimal and cost-effective use of medical services in accordance with the insurance coverage of each patient. As a rule, healthcare providers must reach out to and obtain approval from the respective insurance companies before they can deliver certain medical treatments or services to their patients.
A typical healthcare provider in the United States is reliant on payors, such as insurance companies, to pay the medical bills of the patients who seek their care. Based on the services they deliver, they make their claims to the payor in prescribed format, requesting reimbursement in accordance with the coverage linked to the patient.
Clinical documentation improvement sounds like a silver bullet for effective revenue cycle management - an easy and straightforward solution for all RCM woes of healthcare providers - but it demands executive willpower, systemic transformation (in many cases) and most importantly, the cooperation of physicians, nurses, coders, and other healthcare personnel.
An ineffective charge capture program leads to revenue leakage and delays cash realization. While most organizations focus well on back-office functions such as A/R and denial management, they fail to give due attention to the effectiveness of the charge capture process. Missed charges and inaccuracies in charge capture are the primary causes of ineffective charge capture.
Increasing claim write-offs and decreasing success in denial appeals amplify the already sad state of the financials of hospitals and healthcare systems caused by the current labor shortage and trend of declining reimbursements. Shouldn't hospitals be focusing on denial prevention rather than denial recovery? Here are six tips to help you get ahead in the denials game and recover more revenue.
