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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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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5 Things to do in Austin During AHIP 2017

Posted by Advent Health Partners on May 30, 2017 11:50:21 AM

It's that time of year again - The 2017 AHIP Institute and Expo kicks off June 7, and we're looking forward to an exciting conference. For all the first-timers making the trip down to Texas, you're in luck - Austin is an incredible city filled with food, fun, and plenty of history. To help you navigate the city, our team has put together a guide to this beautiful city for you and your collegues to use when the conference concludes each day. Here are our picks for the top five must-sees across Austin:

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How Payers Can Utilize the Potential of Unstructured Data

Posted by Advent Health Partners on May 23, 2017 8:05:00 AM

Healthcare providers and payers amass huge troves of patient data every day, year in and year out. Health information technology (HIT) regularly manipulates and transmits the structured data from EMR/EHRs for coding, billing and compensation, but what happens to the rest? Of the monumental quantities of information gathered, upwards of 80 percent exist as unstructured data that begs for review and analysis.

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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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The Impact of Paperless Billing on the Healthcare Industry

Posted by Advent Health Partners on May 9, 2017 3:04:38 PM

It's clear that paperless billing offers a dramatic improvement to the revenue cycle management for most healthcare organizations. Leading sources, such as HFMA, point out that the increase in patient responsibility for their own healthcare costs means that there needs to be a dramatic shift in the strategy for patient collection. Accounting for a much higher percentage of the organization's yearly revenue, the traditional model for billing individual patients is no longer adequate to offer sustainability.

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