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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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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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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Utilization Management Tips From Seasoned Experts

Posted by Advent Health Partners on Apr 18, 2017 10:25:11 AM

While utilization management (UM) is often used interchangeably with utilization review, UM’s role oversees the entire spectrum of a facility’s health services, including procedures as well as use of treatment facilities, ensuring that appropriate care is provided without overusing facilities. Utilization tasks include improving clinical efficiency, managing patient appointment, physician time management as well as analyze data for evidence-based best-practice outcomes.

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Data Sources That Could 10x the Efficiency of Your High-Cost Reviews

Posted by Advent Health Partners on Mar 21, 2017 8:10:00 AM

As a hospital, the claim denial review process is a huge headache. It takes a great deal of time to analyze and process each claim, and these high-cost reviews can cost your hospital a lot of money. In 2010, it was estimated that between 10% and 20% of a hospital’s monthly managed care net revenue would be in an open state of denial at any given time.

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Why Going Paperless is Essential for Healthcare Providers

Posted by Advent Health Partners on Feb 17, 2017 3:13:25 PM

While implementation of healthcare technology can mean high initial costs, the potential boosts to ROI for hospitals and other healthcare providers often more than offsets the price. Electronic health records (EHRs) can reduce costs in a number of ways and at a large scale — savings estimates for individual organizations range from $37 million to $59 million over five years. However, its positive impact on the often frustrating claims appeal process is one of EHRs great successes in the field of cost recovery.

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