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denials


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publication date

Revenue Cycle
How Cigna Saves Millions by Having Its Doctors Reject Claims Without Reading Them
ProPublica | March 28, 2023
Internal documents and former company executives reveal how Cigna doctors reject patients' claims without opening their files. "We literally click...
Payer
OIG: Identifying Denied Claims in Medicare Advantage Needed to Combat Fraud
Jay Asser | March 10, 2023
Medicare Advantage (MA) plans aren't required by CMS to include indicators in their encounter data, unlike Medicare and Medicaid.
Payer
Nearly 17% of In-Network Claims Were Denied by ACA Marketplace Plans in 2021
Jay Asser | February 16, 2023
Research finds lack of prior authorization as one of the foremost reasons for denials by non-group qualified health plans (QHPSs).
Revenue Cycle
Preventing and Defending: 2 Keys to Reducing Clinical Validation Denials in the Revenue Cycle
Amanda Norris | February 14, 2023
The director of CDI/utilization review at Avera Health reviews two key areas needed to shore up clinical validation denials.
Payer
Medicare Advantage Insurers Denied Over 2M Prior Authorization Requests in 2021
Jay Asser | February 09, 2023
New analysis further supports the need for stronger policies to streamline the administrative process.
Payer
'We're Still Gonna Say No': Inside UnitedHealthcare's Effort to Deny Coverage to Chronically Ill Patient
ProPublica | February 02, 2023
After a college student finally found a treatment that worked, the insurance giant decided it wouldn't pay for the costly...
Revenue Cycle
Cost of Denials Saw 67% Increase in 2022
Amanda Norris | January 23, 2023
The average health system saw 110,000 claim denials due to prior authorization and other factors in 2022, a recent study...
Revenue Cycle
2023 Set to Be Big Year for Denials Management
Amanda Norris | January 17, 2023
A recent survey highlighted how payment cuts are affecting denial strategies.
Revenue Cycle
6 Revenue Cycle Trends You Need to Track in 2023
Amanda Norris | January 12, 2023
Topics including payer compliance and surprise billing will lead the way for revenue cycle leaders in 2023.
Revenue Cycle
Reducing Denials Tops the List of Priorities for Revenue Cycle Leaders
Amanda Norris | January 04, 2023
Claims denials are increasing between 10%-15% according to a recently released survey.
Payer
Hospital-Payer Experience Worsening Due to Insurer Practices That Delay Care
Jay Asser | November 11, 2022
The American Hospital Association (AHA) finds administrative policies are increasingly overburdening providers.
Revenue Cycle
Revenue Cycle the Most Common Area for Outsourcing Among Hospital Leaders
Jay Asser | November 04, 2022
A Kaufman Hall report highlights pandemic-related impacts of the past year on revenue cycle challenges.
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