Claims Adjudication

For the No Surprises Act arbitration process, 2023 brings a steep fee hike and continuing litigation

The No Surprises Act’s independent dispute resolution (IDR) process is about to become more expensive for healthcare stakeholders. In 2023, the nonrefundable administrative fee due from each party involved in any payment dispute that goes to arbitration will increase from $50 to $350, according to a Dec. 23 memo from CMS’s Center for Consumer Information and Insurance…

Nick Hut December 30, 2022

Clinical audits and denials impact 3% or more of NPR being held in reserve

This pulse survey shows how healthcare organizations are currently tracking health system’s audits and denials from government and commercial payers.

Jennifer Novoseletsky December 1, 2022

Clinical Audits and Denials Research Report

HFMA, with sponsorship by MRO, surveyed 317 healthcare revenue cycle, finance and accounting executives to understand how organizations are handling claim audits, risk exposure, claim tracking, and reserves.

HFMA November 10, 2022

Healthcare News of Note: UnitedHealth Group can proceed with Change Healthcare purchase after a favorable decision in an antitrust case

Healthcare News of Note for healthcare finance professionals is a roundup of recent news articles: UnitedHealth Group cleared to acquire Change Healthcare, standard patient satisfaction surveys need to address DEI issues, and homebound older adults contribute to higher levels of Medicare spending.

Deborah Filipek September 26, 2022

Improve cash flow and cost of reworking denials with the efficientC claim scrubber technology

In five years’ time, denial claims have shot up 20%. Learn about a decision support and claims management technology platform that stops claims before they get denied.

HFMA August 31, 2022

MRA|Revecore’s AcciClaim boosts reimbursements for accident claims

A leading claims management company talks about how it streamlines the complex billing and follow-up activities associated with motor vehicle and workers’ compensation accident claims, driving revenue into healthcare organizations.

HFMA August 31, 2022

Final rule appears to give a boost to providers in No Surprises Act arbitration cases

A new final rule codifies updated criteria for deciding arbitration cases under the No Surprises Act, with providers potentially coming out ahead relative to last year’s interim final rule.

Nick Hut August 22, 2022

Texas-based study raises questions about impact of using additional criteria in No Surprises Act arbitration cases

Study results indicate that ongoing litigation over the independent dispute resolution process established by the No Surprises Act may not have a major impact on outcomes.

Nick Hut June 22, 2022

Utilization review staff may be hurting results when fixing incorrect inpatient admissions

There's a clear financial winner when choosing a method for correcting an incorrect inpatient admission.

Ronald Hirsch, MD June 9, 2022

Some Medicare payments to hospitals for bariatric surgery may be inappropriate, OIG finds

Medicare could have saved nearly $48 million in bariatric surgery payments to hospitals during an 18-month period if coverage rules and guidance were better implemented at the contractor level, according to the HHS Office of Inspector General.

Nick Hut May 17, 2022
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