Claims reimbursement
Providers rely on payer reimbursement to cover the costs of providing healthcare services. Without timely and complete reimbursement, providers may struggle to maintain operations. Effective claims management helps to reduce errors and minimize fraud risk while streamlining the reimbursement process to decrease denials.
Top Stories
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26 Sep 2024
Three-quarters of providers say claim denials increasing
The growing rate of claim denials poses a threat to healthcare revenue cycle management. Continue Reading
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11 Sep 2024
AMA 2025 CPT code set updates focus on novel genetic testing
The AMA's 2025 CPT code set has 420 updates, including new codes for genetic testing, AI medical services, remote therapeutic monitoring and novel surgical techniques. Continue Reading
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21 Jan 2020
American College of Physicians Endorses Single-Payer System
The second-largest physician group backed a single-payer system or public option in a recent policy plan. Continue Reading
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21 Jan 2020
MedPAC Recommends 3.3% Hospital Payment Boost, No Change for Docs
The hospital payment boost would fall short of the current law, but ensure hospitals are paid for the quality of care delivered, MedPAC stated. Continue Reading
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20 Jan 2020
Strategies to Mitigate Shrinking Reimbursement in Emergency Medicine
Emergency departments are under intense pressure to do more with less, and drilling down into clinical and operational data can provide opportunities to offset decreasing revenues Continue Reading
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17 Dec 2019
Out-of-Network Billing for Hospital Care Boosts Spending by $40B
Out-of-network billing was common among hospital-based anesthesiologists, pathologists, radiologists, and assistant surgeons, and these providers were able to negotiate higher in-network rates as a result. Continue Reading
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02 Dec 2019
3 Ways to Build an Effective Hospital Compliance Program
Communication and education are critical to building hospital compliance programs in a value-based world, and technology holds the key to future success. Continue Reading
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25 Nov 2019
6 Ways to Accelerate Physician Reimbursement at Radiology Practices
Radiology practices face challenges to physician reimbursements but improve inefficiencies in more than a handful of ways. Continue Reading
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18 Nov 2019
Automating Revenue Cycle Management Improves Patient Experience
The right revenue cycle management technology can create a transparent, seamless patient experience, which benefits the bottom line. Continue Reading
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12 Nov 2019
Providers Ready for AI Clinical Documentation Improvement Tools
88% of providers are eager to implement clinical document improvement technology that leverages AI, and 93% believe the systems can streamline document creation. Continue Reading
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28 Oct 2019
Federal Hospital Reimbursement to Take $252B Hit by 2029
A recent study found that 12 pieces of legislation and regulatory changes are estimated to decrease federal hospital reimbursement from 2010 to 2029. Continue Reading
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14 Oct 2019
Prior Authorizations, Quality Payment Program Burden Practices
86% of medical group practices in an MGMA report said regulatory burden rose in the last year, with prior authorizations and the Quality Payment Program adding to that burden. Continue Reading
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14 Oct 2019
3 Coding Compliance Strategies to Improve Reimbursement, Quality
Improving clinical documentation quality, leveraging technology, and educating providers are key ways hospitals improve coding compliance in a value-based world. Continue Reading
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07 Oct 2019
Developing a Hospital Claim Validation Strategy to Prevent Denials
A comprehensive hospital claim validation strategy that prevents denials and improves efficiencies hinges on the right blend of retrospective and pre-bill reviews. Continue Reading
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17 Sep 2019
Hospitals Retain 91% of Profit from Physician-Administered Drugs
Hospital keep a greater share of the gross profit margin on physician-administered drugs, indicating a need to level the playing field for physician practices, according to some experts. Continue Reading
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20 Aug 2019
6 Challenges of End-to-End Automation for Prior Authorizations
Data inconsistency, limited vendor solutions, and lack of interoperability are among the top barriers preventing prior authorization automation, CAQH reports. Continue Reading
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06 Jun 2019
How Advocate Aurora Health Streamlined Prior Authorizations
The health system reduced the burden of prior authorizations while upping medication adherence by automating the process in the EHR and creating an authorization team. Continue Reading
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11 Mar 2019
Why Do We Need Artificial Intelligence in Healthcare?
Artificial intelligence in healthcare can lead to immediate gains by reducing inefficiencies in the revenue cycle. Continue Reading
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07 Jan 2019
Maximize Hospital Revenue with a Holistic Insurance Discovery Strategy
Looking beyond self-pay accounts for insurance discovery and identifying valuable coverage information helps both recover—and increase—hospital revenue. Continue Reading
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10 Dec 2018
Getting the Medicare Cost Report Right the First Time
Data analytics can help hospitals submit a complete and accurate Medicare cost report in the face of constant rule changes and an uptick in audits. Continue Reading
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03 Dec 2018
Healthcare Payment Integrity is Vital to Maximizing Reimbursements
Identifying underpayments or claiming supplemental reimbursement is resource-intensive, but a healthcare payment integrity solution can recoup lost revenue. Continue Reading
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17 Sep 2018
How Automating Payer Enrollment Reduces Time to Reimbursement
A lack of automation for payer enrollment and other claims management processes is delaying reimbursement, but outsourcing payer enrollment can reduce the wait. Continue Reading
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10 Sep 2018
RCCH Uses Predictive Analytics to Boost Claim Denials Management
A Tennessee-based healthcare organization uses predictive analytics to identify high-value denials and add accountability to their claim denials management strategy. Continue Reading
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10 Sep 2018
Using Payer Enrollment to Jumpstart Revenue Cycle Optimization
Outsourcing payer enrollment services helps healthcare organizations streamline the enrollment process, navigate payer rules, and monitor revalidation. Continue Reading
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04 Sep 2018
Artificial Intelligence Ensures Payer, Provider Pay Covers Costs
Gateway Health Plan is using artificial intelligence to improve its risk adjustment programs, which ensure the payer and its providers receive reimbursement that covers a patient’s total cost of care. Continue Reading
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16 Jul 2018
Overcoming the Top Challenges of Claims Denial Management Audits
Increasing efficiency and improving revenue are top priorities for health care providers with a big focus on improving prior authorizations and eligibility before an episode of care. Continue Reading
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23 Oct 2017
4 Strategies for Merit-Based Incentive Payment System Success
Eligible clinicians can prevent a Merit-Based Incentive Payment System penalty in 2017 by selecting the right measures and engaging their vendors and physicians. Continue Reading
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06 Oct 2017
Maximizing Revenue Through Clinical Documentation Improvement
A strong revenue cycle rests on accurate, timely data. Clinical documentation improvement offers an opportunity to improve coding and maximize reimbursement. Continue Reading
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28 Sep 2017
Cancer Care Costs 60% Higher at Hospitals Vs Independent Orgs
Cancer care costs for chemotherapy and physician visits are significantly less at independent community oncology practices, a study showed. Continue Reading
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11 Aug 2017
Key Strategies for Succeeding with Healthcare Bundled Payments
In order to succeed with healthcare bundled payments, providers must engage post-acute care providers, leverage data analytics, and improve their patient engagement strategies. Continue Reading
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20 Jul 2017
3 Challenges Providers Face with Healthcare Bundled Payments
The top challenges of healthcare bundled payments include achieving scale, leveraging post-acute care resources, and managing uncontrollable costs. Continue Reading
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09 Jun 2017
The Difference Between Medicare and Medicaid Reimbursement
Medicare and Medicaid reimbursement models vary according to federal and state regulations, but both are striving to embrace value-based reimbursement. Continue Reading
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11 May 2017
3 Best Practices for Hospital Claim Denials Management
Implementing claim denials management best practices is key to ensuring hospitals maximize claims reimbursement revenue and prevent denials. Continue Reading
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10 Mar 2017
Top 4 Claims Denial Management Challenges Impacting Revenue
Common claims denial management obstacles for providers include quantifying denial rates, using manual processes, receiving preventable denials, and appealing claims. Continue Reading
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04 Nov 2016
How to Maximize Revenue with Improved Claims Denials Management
Enhancing claim denials management strategies can help providers recoup lost healthcare revenue and maximize reimbursements. Continue Reading
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02 Aug 2016
4 Medical Billing Issues Affecting Healthcare Revenue Cycle
Addressing these four common medical billing challenges can have a positive impact on the healthcare revenue cycle. Continue Reading
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15 Apr 2016
Defining the Top 10 Terms of Healthcare Revenue Cycle Management
MACRA, MIPS, accountable care, and supply chain management are among the top terms used by healthcare revenue cycle pros. Continue Reading
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12 Apr 2016
Key Ways to Improve Claims Management and Reimbursement in the Healthcare Revenue Cycle
To keep pace with changes to healthcare reimbursement, hospitals and healthcare organization need to reduce inefficiency in revenue cycle management. Continue Reading
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21 Sep 2015
3 Strategies to Improve Healthcare Supply Chain Management
The evolution and progression of supply chain and reimbursement tactics and procedures within the healthcare industry serves as a keen present focal point. Continue Reading
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30 Mar 2015
Quantify Denial Rates for Smooth Revenue Cycle Management
The ability to swiftly and economically scrub claims and quantify denial rates is critical to ensure smooth revenue cycle management. Continue Reading
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09 Mar 2015
What Steps Comprise the Life Cycle of a Medical Claim?
It is important to recognize and distinguish each stage from the other within the total life cycle of a medical claim to decrease errors and cost. Continue Reading
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04 Nov 2014
Examining Differences Between Medicare, Medicaid Reimbursement
While Medicare and Medicaid are similar programs, there are different challenges when it comes to reimbursement. Continue Reading