Articles Tagged With: denials
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Target Low-Hanging Fruit in Preventing, Overturning Denials
The keys to preventing and overturning payer denials are to collect data to identify problem areas and to train staff in best practices. The case management team should understand the information each payer wants and how best to share those data.
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Understanding Medical Necessity Improves Utilization Review Process, Reduces Denials
The case management team should be trained thoroughly on utilization review and medical necessity to avoid payer denials. The goal is to ensure patients receive medically necessary, high-quality care. -
Survey: Prior Authorization Hassles Persisted Mostly Unabated Through 2020
A public health emergency did not seem to remove many bureaucratic roadblocks, to the frustration of U.S. physicians.
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If CPT Code Changes, Patient Access Can Obtain Payment
Patient access can intervene to stop an unauthorized test, assuming it is not emergent or urgent — or find out if the patient wants to go forward anyway. Registrars' expertise makes all the difference on whether the hospital is paid, and how quickly. Possibly, the health plan will agree a new authorization is unnecessary — as long as the clinical records are sent with the claim.
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Revenue Depends on Correct CPT Codes; Beware Sudden Changes
The revenue loss caused by CPT code changes is nothing short of staggering. When it comes to CPT codes that change after service, one of the biggest challenges is in the surgical space. Learn how some patient access departments are proactively addressing this problem.
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Data Are the Key to Avoiding Claims Denials
Claims denials have increased by 11% nationally since the onset of the COVID-19 pandemic, according to an analysis. Almost half of claims denials are caused by front-end revenue cycle issues, including registration/eligibility, authorization, or service not covered. Implementing a process to check eligibility at multiple points throughout the revenue cycle will go a long way in preventing this common denial from occurring.
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Centralized Utilization Management: The Good, the Bad, and the Best Practices
Challenged with employing enough staff in case management departments, the need for expertise in every role, and the increased requirements from payers, case management leaders are evaluating centralizing utilization review. This centralization carries both benefits and challenges, some of which are amplified because of the current healthcare climate.
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Basic Coding Knowledge Allows Patient Access to Stop Denials
Inaccurate coding causes compliance issues, more denials, lost revenue, and negative patient experiences. More precise and accurate information from the onset sets the stage for correct billing, cleaner claims, and fewer denials.
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Uncertainty on Auths Means Anxiety for Patients, Registrars
Many health plans waived some authorization requirements during the COVID-19 pandemic, but the actual effect on revenue is unclear.
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When It Is Life and Death, No Time to Wait for Authorization
Denied claims for urgent, medically necessary procedures are no laughing matter. Patient access staff have to appeal each denial, a time-consuming and expensive process. A New York law states that if a patient presents with unexpected complications or requires additional services in the course of treatment, a health insurer will no longer be able to deny payment due to lack of prior authorization.