denial management
publication date
Payer
Consumer Advocates, Union, Cheer California's Health Plan Accountability ActCivil penalties for illegal denial of coverage were increased from $2,500 to $25,000 per violation.
Payer
Molina Healthcare of California Slapped with $1M Fine for Delayed PaymentsMolina has also paid $80 million in disputed and delayed claims to providers, plus $1.8 million in interest.
Revenue Cycle
Measuring Revenue Cycle Health Through Denials ManagementAn organization's denial rate is a good barometer of its overall financial health and the soundness of its revenue cycle....
Payer
L.A. Care Health Plan Fined $55M For 'Deep-Rooted, Systemic Failures'The public plan acknowledged problems with its grievance resolution process, but called the fine excessive.
Revenue Cycle
Avoid Paying Back $900K: Prepare Your Rev Cycle for an OIG AuditThe OIG plans to target organizations' revenue cycle in audits of severe malnutrition reporting and billing.
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...