Articles Tagged With: payer
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Thinking Like a Payer
Part of what makes so many case managers successful is their ability to understand countless roles within healthcare and move between them smoothly. Whether managing discharges, providing social work support, or completing utilization review, the case management experience often is varied. However, many struggle in the quest to work more seamlessly with payers. -
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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‘Uncollectible’ Claims Just Need Fresh Approach
Stat diagnostic tests are triggering claims denials because payers dispute the urgency. This article discusses steps patient access can take to increase the chance of a successful appeal.
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Payer Says Service Is Non-covered? Patient Access Put in Difficult Position
Patient access faces difficult conversations with patients if services are non-covered. This article discusses steps to help stop lost revenue.
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Did Patient’s Insurance Change? Auths, In-network Status May Change Too
Patients often fail to tell patient access if their coverage changes, and eligibility verification software responses do not always catch it. This article discusses steps that can help prevent claims denials.
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Avoid Lost Revenue Caused by Insurance Eligibility Mistakes
Patient access staff can interpret responses from insurance eligibility software incorrectly, causing lost revenue. This article provides tips to help prevent mistakes.
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Are Payers Meeting Their Own Requirements for Auths? Find Out What Contractual Language Says
Patient access departments are using contractual language to overturn unfairly denied claims.
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Case Management-Revenue Cycle Partnership Pays Off
At Saint Francis Hospital in Hartford, CT, the revenue cycle team is a strong partner of case management, reports Beth A. Greig, RN, MSN, MBA, ACM, director of case management, healthcare value, and efficiency at the 617-bed hospital.
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Know the Payer Rules to Maximize Reimbursement
In today’s world, it is imperative for the case management director to make sure the case management staff receives continuous training and education around payer rules and regulations, and the financial implications of what they do, says Mindy Owen, RN, CRRN, CCM, principal owner of Phoenix Healthcare Associates in Coral Springs, FL, and senior consultant for the Center for Case Management.
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Prevent denials in the first place — Training is ‘paramount’
Errors or typos made by registrars during the collection of information or during the data entry process are “extremely prevalent” in claims denials, according to Brinn Leach-Wilson, a Merritt Island, FL-based consultant with BHM Healthcare Solutions.