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.
A global pandemic forced rapid shifts in an institution that already had been a focal point of calls for change: health care. The panelists brought out perspectives on the impact of COVID-19, emerging technologies in healthcare, hospital finances, shift to value-based care, rise of wearable devices and interoperability.
The post-pandemic path to recovery for hospitals and healthcare systems is steep with multiple challenges, including a severe shortage of clinical and revenue cycle labor, and unprecedented inflation. Initiatives such as value-based care, patient experience improvement, and process automation, on the other hand, are screaming for investments.
Declining reimbursements, rising consumerism, demand for improved patient experience, transition to value-based care, COVID-19's impact, manpower shortage and other factors distract healthcare providers from their core goal of delivering quality healthcare to their patients. They must respond with innovative approaches that could depend largely on finding the right outsourcing partner for the scalability and domain expertise the business needs.
Outsourcing is often associated with the idea of letting go. And letting go is about uncertainty and anxiety about results. By choosing the right partner, you can free up the time and find the investments for the strategic initiatives to propel your organization forward. In our experience, outsourcing can help you in three critical areas - Scalability, Automation, and transparency
