4 Steps to Win More Appeals, Reduce Denials, and Improve your Bottom Line

Posted by Advent Health Partners on Nov 2, 2017 9:30:00 AM

The American Medical Association found payers return up to 29 percent of claim lines with $0 for payment, while a MGMA study found more than half of denied claims are never reimbursed.  Because the American population is aging and requiring more and more care, healthcare providers are often having to transition patients across different/multiple setting and specials - requiring multiple claims. As a result of these factors, complexity increases.

If providers can begin closing the documentation gap that leads to medical necessity denials, your organization will see a positive impact on your bottom line as well and patient care and satisfaction.

Healthcare providers everywhere are striving to answer this question: How can we better manage denials?

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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:

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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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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 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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How to Evaluate Medical Necessity With More Accuracy

Posted by Advent Health Partners on Mar 16, 2017 8:50:00 AM

Medical necessity continues to be one of the most common reasons that claims are denied by Medicare and other payers. While your organization may also note other areas where processing claims should be improved, it's likely that medical necessity falls into that category. The good news is that most denials can be prevented with proper documentation and an organized, efficient protocol to evaluate medical necessity in patients.

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