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:

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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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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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6 Common Reasons for Hospital Claim Denials

Posted by Advent Health Partners on May 15, 2017 8:35:00 AM

Since 2008, the AMA has taken the lead to bring reform to the medical billing/payment system, according to a 2014 article in Medical Economics. While healthcare organizations may still end up with a running 2 to 5 percent denial rate despite their best efforts, the AMA believes a full 90 percent of denials can be avoided from the outset. While insurers have taken the step to increase claims efficiencies with electronic filing systems, even so, provider errors and claim omissions can't be cured merely with improved communications.

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How to Stop Medicare Claim Denials Due to Medical Necessity

Posted by Advent Health Partners on May 5, 2017 11:25:32 AM

With the shift towards value-based care coupled with the ICD-10 coding requirements, Medicare claim denials for medical necessity will most likely continue to plague your healthcare revenue cycle. Because medical necessity denials usually stem from inadequate documentation on the claims, the first line of attack to conquer the problem must come from physician documentation. ICD-10 calls for greater specificity than ever before. What may have passed under ICD-9 as proper coding for medical necessity may be insufficient today.

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5 Common Struggles in Healthcare Denial Management

Posted by Advent Health Partners on Apr 26, 2017 10:16:51 AM

Claims management is among the primary RCM hurdles faced by providers and can also pose challenges for payers. Becker's Hospital CFO reports that hospitals lose anywhere from 1% to as much as 4-5% of net revenue because of denial write-offs. While single-digit percentages seem small, they can translate to at least $2 to $3 million in lost revenue annually. Industry experts describe the most common healthcare denial management challenges and how to overcome them.

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5 Ways Providers Can Reduce Denials In Medical Billing

Posted by Advent Health Partners on Apr 21, 2017 8:05:00 AM

Medical claims are an unavoidable part of life for physicians and healthcare providers. Unfortunately, it often seems like claim denials are equally as unavoidable, despite the significantly negative impact they can have on revenue cycle management. In truth, it's not always as difficult to reduce denials in medical billing as you may think. The key lies in understanding why your claims are being denied in the first place. Once you have a solid grasp of the reasons, you can implement changes that will reduce denials going forward.

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What Makes Healthcare Denial Management Services Excel?

Posted by Advent Health Partners on Apr 13, 2017 10:42:25 AM

Denial has such a negative connotation. However, with an effective technique, it's possible to turn a denied claim into a paid claim. It just sometimes requires effort and a change of approach. Here are five strategies to improve your healthcare denial management.

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