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denial management in healthcare

Improving Denial Management in Healthcare & Medical Billing

When insurers deny medical claims, it takes a bite out of your revenue every year. Nationwide, this annual loss amounts to $262 billion, according to Modern Healthcare. As a matter of fact, insurers deny an average of 9 percent of claims overall, which means that your staff is engaged in a continual process of managing and appealing…

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Revenue Integrity & Capture – Who’s Herding the Cats?

Cross functional processes can be difficult to manage in hospitals. One reason pertinent to Revenue Integrity is that typically, the organization structure is a series of vertical disciplines with differently defined focus (HIM, PFS, PATIENT ACCESS, ANCILLARY DEPARTMENTS, MD’s, et.al.). This structure can be and is very effective in many hospitals. However, revenue integrity management…

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Revenue Cycle Processing Backlogs Are Not “NORMAL”. It’s time to raise the bar – eliminate BACKLOG TOLERANCE!

I talk every week with Revenue Cycle Leaders from all types of hospitals around the country. When I ask how things are going, there are many common responses that reflect current concerns and challenges they are facing. These include conversion issues, staffing constraints, volume fluctuation, talent acquisition/retention, cooperation among stakeholders, change in payor practices and…

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Should Hospitals Leverage Outsourced Coding or Keep It Internal?

Hospitals have adapted many different coding models. Most are designed around contributing factors that differ from one facility to the next. However, there are three models that arguably prevail. The following is a summary of each; MODEL I-INTERNAL All coding functions are managed and performed by internal staff/employees. The function is generally housed at the…

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RCM Consultants

Hospital Classification: A New Normal For Financial, IT and RCM Professionals

Hospitals have been and still are classified in various ways, depending on the purpose of the hospital classification and how it is to be used. Examples include ownership, bed capacity, service capacity, specialty, teaching, acute care, critical access, location, research and there are many others. A “new normal” classification methodology has emerged and it is…

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Revenue Cycle Management In 1951: It Used to be a Lot Easier…Or Was It?

The above image is an actual hospital bill and accompanying explanation of charges used in 1951. Just think of the things that we didn’t have to manage back then. A short list might include coding, claim edits, massive denials, contract payment compliance, Medicare/Medicaid (both started in 1965), managed care contracts, HIPPA regulations, “patient-friendly” billing initiatives,…

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The Characteristics of Leaders and Successful People

I don’t know about you but I am growing immune to the voluminous “LISTS” I see in social media about leadership and success. LinkedIn, social media forums such as Facebook, and blogs are recently inundated with posts about leaders, leadership and successful people. For example, just this year alone 167 Habits, 340 Behaviors, 62 Graphic…

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Patient Access Training Designed to Connect “Front End” Data Collection and Data Entry Directly to UB 04 Form Locators and Registration Screens Can Be An Effective Way To Improve Cash Flow and Denial Rate

People are more careful about their work when they understand the importance of what they are doing and how it impacts the organization. Recent findings suggest that this is particularly true for millennials, but it certainly applies to the broader work force as well. Here is one way to help access associates better understand their…

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Use a Cash Acceleration Team to Optimize RCM

There are many explanations for sluggish cash performance and obviously, understanding causes may be useful in preventing recurrence. Meantime, you have a backlog and the objective is to get caught up. That’s where a Cash Acceleration Team can be helpful. What is a Cash Acceleration Team? It is a highly customized temporary external resource allocation…

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