by | Feb 20, 2024 | Appeal Management, Article, Health Systems & Hospitals, Revenue Integrity Consulting, Utilization Management
As the volume of denials continues to increase, hospitals and health systems need a more proactive approach to denial management and prevention. Providers are encouraged to move from a denial management framework to a denial prevention framework to capture appropriate...
by | Feb 20, 2024 | Analytics and Reporting, Appeal Management, Article, Health Systems & Hospitals, Revenue Integrity Consulting, Utilization Management
A hospital’s denial issues vary based on the organization, and because of this, sometimes pinpointing potential denials can be difficult. Moving from a management to a prevention model is a slow process, and issues can potentially arise if denials by the department...
by | Feb 13, 2024 | Appeal & Claim Technology, Appeal Management, Article, Health Systems & Hospitals, Revenue Integrity Consulting, Utilization Management
For the past few years, Medicare has been testing out new ways to bundle claims. The goal of this bundled claim switch is to improve care and reduce costs. A few apparent benefits in the bundled claims model have already been tested. One is simplifying the billing...
by | Mar 16, 2023 | Article, Health Systems & Hospitals, Utilization Management
What is a health system without patients, or patients without a health system? Patient satisfaction is overwhelmingly important to the growth and success of a health system, and in turn, they expect the utmost care. That doesn’t mean the system is without its...
by | Nov 17, 2022 | Article, Health Systems & Hospitals, Utilization Management
What is Utilization Management? Utilization Management assures your patients receive the care they need and provides a base to start focusing on denial prevention. Utilization Management comprises three assessments: prior authorization, pre-bill reviews, and...
by | Nov 10, 2022 | Article, Health Systems & Hospitals, Utilization Management
More than one-third of nurses plan to leave their positions by the end of 2022, prolonging the nursing shortage. In addition to nurses, there is a strong trend of struggling to retain revenue cycle staff. Approximately 25 percent of healthcare finance leaders report...
