Advent Health Partners

Recent Posts

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.

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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.

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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.

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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.

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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.

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Creating a Patient-Friendly Revenue Cycle For Your Patients

Posted by Advent Health Partners on Jul 5, 2017 8:25:00 AM

With patients bearing increasing responsibility for their medical expenses, hospitals need to regard them as informed customers, and consider collections in terms of a business model. Since the revenue cycle involves so many points of contact with consumers, it's critical that operations are patient-centered from beginning to end.

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7 Ways to Prevent Claim Denials Before They Happen

Posted by Advent Health Partners on Jun 28, 2017 6:05:00 AM

Claim denials plague every hospital. As reported in a 2016 article in Becker's Hospital CFO Report, payers deny or delay upwards of 20 percent of all submitted claims. Organizations that wait for denials to occur before taking action may be as much to blame as the complexities of payer rules and regulations for lost or reduced revenue. Leaders within revenue cycle departments should take every measure to prevent denials in the first place. Fewer resources go into prevention than that which goes towards correction on the back end.

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CAVO: Find Your Buried Treasure with the Right Technology

Posted by Advent Health Partners on Jun 21, 2017 7:58:44 AM

Data is arguably your most important asset. Google set the standard and thousands of companies are focused on understanding the world through data. With the coming renaissance in machine learning, your data is even more valuable because it will be possible to track trends and draw conclusions from both discrete and non-discrete data.

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6 Strategies for Improving the Payer Provider Relationship

Posted by Advent Health Partners on Jun 13, 2017 1:46:54 PM

Contention over claims and contracts can cause the payer provider relationship to become strained. Despite improvements in how insurers and physicians collaborate, their relationships are often stymied by a lack of trust. However, adopting these six strategies can help insurers and providers build credibility, making the claims process easier to navigate.

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Why Pre-Bill Reviews are Essential for Healthcare Providers

Posted by Advent Health Partners on Jun 6, 2017 3:52:24 PM

Have you calculated your hospital’s rate of claims denied on the first pass lately? If not, don't be surprised if it rests at or above the 2014 industry benchmark of 20 percent. That's one in five claims denied on the first pass. After reworking claims and pursuing appeals, if necessary, you may still face a 5 percent ongoing denial rate. Imagine, though, how much revenue you could keep if you received your due compensation on the first billing effort and seldom had to re-submit or appeal claims. Would it be substantial enough to implement a technology-driven pre-bill review process?

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