Clinical labs typically generate low-dollar/high-volume claims which many hospitals don’t aggressively pursue. However, hospitals can generate a substantial source of revenue by taking a more aggressive and systematic approach to lab denials.
Radiologists face unique challenges when it comes to getting paid. Coding for imaging is complex and multi-faceted, and documentation must be thorough and precise. In addition, unlike most other specialists, radiologists are usually dependent on the referring physician’s office or emergency department to document medical necessity or ensure that any required prior authorizations are obtained.
HFRI is excited to join forces with PARA to deliver an unmatched revenue cycle solution that will further reduce AR cycle time, help providers generate more revenue, and improve patient satisfaction with increased pricing transparency.
Hospital emergency departments serve as important gateways for inpatient admissions, making it essential to capture patient information, especially insurance data, at the time of service to help prevent denials.
Despite a high probability for success, just one percent of Medicare Advantage (MA) reimbursement and pre-authorization denials were appealed by providers and beneficiaries between 2014 and 2016. Hospitals and other organizations need to pursue the MA appeals process to ensure every dollar you’re entitled to is received.
Like an injury that won’t heal, claim denials represent a chronic and growing financial problem for hospitals and other providers, both in terms of lost revenue and the ongoing costs of remediation. Using intelligent automation to automate root cause analysis and the accounts receivable recovery and resolution process can have additional benefits over standard technology.
Like costly home improvement projects gone awry, electronic health record (EHR) and revenue cycle management software implementations don’t always pan out as intended for hospitals and health systems. But with the right tools and proper planning, potential issues can be minimized.
Hospitals often assume they have no choice but to accept denial write-offs as an unfortunate but inescapable fact of life. But just like football teams that push the ball over the goal line in a final effort to score a touchdown on a fourth down, hospitals and health systems are turning to pre write-off insurance collections to make one last attempt to pull cash to their bottom line.
If you want to be sure payers consistently reimburse your organization in a timely and accurate manner, it’s important to comply with all contractual requirements – while making certain the payer does, too. Learn more about two major issues that can trigger contractual denials.
Insurance coverage issues that result in denials are a bit like electrical problems: If there is a faulty link or bad connection between the patient and payer, the circuit is broken, a denial is sparked and power–in this case, cashflow–is interrupted. Learn how to trace the provider-payer “wiring” early to ensure proper reimbursement.
