Part I in this two-part series touches on ensuring data integrity and primarily focuses on the ambulatory environment.  According to an American Medical Association (AMA) benchmark survey, the number of physicians employed by healthcare systems now exceed those remaining in private practice. Employed physicians made up 47.4 percent of all patient…
Typical CDI programs are intended to drive reimbursement through diagnosis securement, contributing to improved case mix index. The COVID-19 pandemic is placing monumental financial stressors upon hospitals, with added costs to treat patients with high acuity and long length of stays, coupled with significant revenue loss associated with postponement of…
A year before CPT® rules change, payers are expected to crack down on E&M codes. Even as a major change to outpatient evaluation and management (E&M) codes looms next year, a development that would reduce the documentation burden on providers, commercial insurance companies are cracking down this year on E&M…
Three revenue cycle tips are provided to reduce denied claims. Claim denials represent millions of dollars in lost and delayed net reimbursement annually. According to the American Medical Association (AMA), cost estimates of inefficient healthcare claims processing, payment, and reconciliation top out at $210 billion per year. Denials are so…
Quality work reduces the burden of the denial management process. When my children were young, they really enjoyed the movie “The Neverending Story.” It’s about a boy who reads a magical book that tells a story of a young warrior whose task is to stop a dark force called “The…
An estimated 20 percent of all healthcare claims in the U.S. are denied each year. The financial impact for some hospitals is estimated to be in the range of $250 million annually.When denials are appealed, success rates can vary from 55 to 98 percent.Some hospitals are moving from denial management…