Advent Health Partners

Recent Posts

How to Prevent the 4 Most Common Medical Billing Denials

Posted by Advent Health Partners on Oct 10, 2017 9:30:00 AM

In healthcare systems, average medical billing denial rates range from 5-10%, with better performers averaging 4%. Some organizations even see denial rates as high as 15-20%.

The good news is, many medical billing denials can be avoided. Reducing denials even by a fraction of a percent can have a substantial impact on your organization’s bottom line.

If your organization is able to understand the different types of medical billing denials, pinpoint the most common billing problems and take steps to avoid them, you could collect more of what you deserve and transform your bottom line. Here’s how to make it happen:

Read More

Appeal Letter Best Practices for Providers to Overturn More Denials

Posted by Advent Health Partners on Oct 4, 2017 9:30:00 AM

When defining medical necessity, most payers base their payment off of evidence-based medicine and guidelines of appropriate medical care by the appropriate healthcare provider.  

Some health coverage denials, such as when a healthcare provider enters a wrong code on a claim form, are simple mistakes that easily resolved. But there are other issues can be much more difficult - centered on complex medical questions like whether a certain medical treatment is appropriate. Battling health insurers when they refuse to cover certain treatments can be exasperating, time-consuming and costly. But, through a disciplined denial management program, providers can fortify their cases and better address complex denials.

Read More

How Provider Utilization Management Reduces Costs on the Front End

Posted by Advent Health Partners on Sep 11, 2017 3:52:30 PM

CMD- How to Manage Provider Information to Improve Your Organization's Processes.png

With the majority of Americans now enrolled in privately or publicly funded health plans that use utilization management (UM) programs as a primary cost-containment strategy, it has never been more important for hospitals to follow a process that is clinically sound and routing patients accurately/efficiently than now. Becker’s highlights utilization review as a key component of leveraging case management best practices with the revenue cycle, which paves the way for improved workflows.

Read More

How Technology Can Solve Payment Integrity Challenges

Posted by Advent Health Partners on Aug 29, 2017 1:30:00 PM

Payment integrity has become an essential part of the process for healthcare organizations, but it's traditionally been given a lower priority in resources. As Healthcare Tech Outlook noted, organizations often devote their IT and analytics resources to specific concrete areas, such as billing or claims. If your organization focuses more on payment integrity as an umbrella to ensure that the overall revenue cycle management of your organization runs smoothly, technology and analytics can significantly improve your projected data and bottom line.

Read More

Top 4 Ways to Reduce and Manage Medical Necessity Denials

Posted by Advent Health Partners on Aug 22, 2017 1:30:00 PM

With more insurance and governmental regulations increasingly tightening claims payouts and other changes faced by hospitals and physician offices, good claims management and reducing the potential for denials is more critical than ever, with the average cost of reworking claims estimated at $25 per claim. Here are four key areas to watch for reducing denials while increasing revenues:

Read More

5 Best Practices for Health Insurance Appeal Letters

Posted by Advent Health Partners on Aug 15, 2017 1:30:00 PM

Although most hospital administrators know that lost revenue is a problem, they may be unaware of just how much of it is due to claim denials. While it's critical to optimize your claims-management processes to minimize the number of denials in the first place, some denials are inevitable. In these instances, revenue cycle managers and their teams can use the following strategies when preparing health insurance appeal letters to increase the possibility that denials won't result in write-offs.

Read More

3 Ways to Improve Your Clinical Appeals Success Rate

Posted by Advent Health Partners on Aug 9, 2017 2:30:00 PM

Hospitals and other healthcare providers are using substantial amounts of resources and losing money from costs and inefficiencies within their revenue management cycles. The AMA estimates that as much as 25–30 percent of national healthcare expenditures are directly due to these transaction and related costs, with up to 15-20 percent of submitted gross charge claims being denied by payers. Given that the industry standard of expected denials is in the 3-5 percent range, anything significantly higher is cause for concern.

Read More

Valuable Insights Healthcare Providers Need to Know in 2017

Posted by Advent Health Partners on Jul 25, 2017 4:50:05 PM

There’s a massive amount of content out there for healthcare providers to gain insight into pertinent topics. To ease the headache of searching, we have compiled a list of resources that providers have found most valuable and relevant in 2017.

Read More

Understanding the Difference Between MDM and Medical Necessity

Posted by Advent Health Partners on Jul 18, 2017 2:42:31 PM

The claims process is complex, requiring accurate supporting documentation and multiple codes.  To ensure they receive payment, providers must be certain to furnish payers with adequate data to justify why they opted for a particular test, procedure, or follow-up visit.  While some clinicians include copious notes in the patient record, the emphasis should be on quality rather than quantity when documenting MDM and medical necessity.

Read More

How Can Unstructured Data Benefit Your Healthcare Organization?

Posted by Advent Health Partners on Jul 11, 2017 5:41:28 PM

Big Data is everywhere and it's likely that your organization is compiling massive amounts of information. The question is, how well is your organization utilizing this data? While technology has allowed you the ability to capture most information, and many organizations have upgraded their old paper filing system to an EHR system to better manage information, the healthcare industry still struggles with the use of their gathered information.

Read More