denial management
publication date
Payer
'An Arm and a Leg': Hello? We Spend 12M Hours a Week on the Phone With InsurersIn many cases, the companies are not actually getting paid to provide insurance.
Payer
Major Insurers Running Billions of Dollars Behind on Payments to Hospitals and DoctorsHospitals are also dealing with a spike in retroactive claims denials by UnitedHealthcare.
Nursing
Cali AG Providers on Data Privacy, Anti-Implicit Bias TrainingStakeholders are urged to take proactive steps to protect patient data, provide perinatal staff with anti-implicit bias training.
Payer
California Supreme Court will hear CMA lawsuit against AetnaCMA claims that Aetna's actions violated the state's Unfair Competition Law.
Revenue Cycle
Emergency Physicians Call United Healthcare's ED Denial Policy 'Dangerous'The American College of Emergency Physicians said that it "firmly believes that the new policy is in direct violation of...
Revenue Cycle
United Healthcare Will Deny or Limit Coverage for ED Commercial Claims it Considers Non-EmergentThe new policy will apply to "commercial fully insured ED facility claims in many states for dates of service on...
Clinical Care
Q&A: Medical Necessity DocumentationOne of the best defenses is a strong offense. This can be achieved by including a physician's medical necessity documentation...
Revenue Cycle
How Hiring A Denial Management Registered Nurse for Rev Cycle Contributed to $6M ROIThe UM denials management nurse has helped the rev cycle recognize trends, gain better insight into the tactics payers use...
Revenue Cycle
Q&A: New UnitedHealthcare GuidelinesWhile UnitedHealthcare will provide organizations with criteria to make status decisions for patients, it will not provide hospitals with the...
Revenue Cycle
CMS Issues Reminder on MSP Billing Rules, Appeal OptionsOrganizations are required to determine whether Medicare is the primary or secondary payer prior to submitting a claim.
Revenue Cycle
Using Denial Analysis DataPerforming denial analysis on a regular basis will enable you to identify the top reasons for denials and develop action...
Revenue Cycle
6 Action Items for Your Denials Management PlanKimberly Scaccia, vice president of revenue cycle at Mercyhealth, outlines a methodical, multistep action plan for creating a denials management...