Denials Management

How to Optimize Your Revenue Cycle through In-depth Assessment and Strategic Process Improvements

By adopting a comprehensive approach that includes regular assessment, process optimization, staff education and measurement, healthcare organizations can enhance efficiency, reduce costs and ultimately improve their financial health. Download this report to learn more.

HFMA February 20, 2024

How healthcare finance organizations are working to become more resilient

Seven healthcare financial executives share their strategies for tackling the challenges of financial management in the current environment in this roundtable.

HFMA January 30, 2024

Medicare beneficiaries would have new options for appealing their hospital patient status under a proposed rule from CMS

A proposed rule from CMS would affect the appeals process for some patients whose status is reclassified from inpatient to outpatient observation during a hospital stay. After a 2020 court ruling that was upheld at the appellate level in 2022, the U.S. Department of Health and Human Services and CMS were obligated to create additional…

Nick Hut January 17, 2024

No Surprises Act end-of-year update: A new administrative fee is set, and the arbitration portal is fully functional

Bringing out-of-network payment disputes to arbitration under the No Surprises Act in 2024 will be less expensive than previously described. In a final rule, the U.S. Departments of Health and Human Services (HHS), Labor and Treasury set the administrative fee for using the independent dispute resolution (IDR) portal at $115 per case, effective 30 days…

Nick Hut December 20, 2023

Understanding the true cost to collect requires focusing on high-level KPIs

Revenue cycle management leaders from around the country share their perspectives on defining and maintaining a high-performance revenue cycle and the challenges they face in working to enhance revenue cycle management.

HFMA December 12, 2023

Prior authorization in Medicare Advantage remains in the policy spotlight as 2024 regulations take effect

Healthcare policymakers and stakeholders continue to mull the need for guardrails to ensure optimal customer service among Medicare Advantage (MA) health plans. The American Hospital Association wrote a Nov. 20 letter to CMS stating that MA plans are looking to skirt policies designed to ensure straightforward coverage of essential healthcare services. These policies, finalized earlier…

Nick Hut December 1, 2023

In response to a congressional RFI, provider advocates give input on ways to bolster rural healthcare

Hospital and physician groups were among the respondents to a request by a key congressional committee for information on improving rural healthcare. In an RFI issued in September, the House Ways and Means Committee sought policy solutions for augmenting access to — and the quality of — healthcare in relatively remote areas. “The committee will…

Nick Hut October 19, 2023

Stemming the outpatient profit squeeze with a revenue cycle workflow gap analysis

Hospital and health system outpatient, outreach and ancillary services are often confined to EHR systems to manage their billing. Designed for bigger-ticket, lower-volume claims, these systems lack specific front-end intelligence, system connectivity, and automation necessary to efficiently manage these departments’ unique billing need. Too often, the result is an unnecessarily high number of submission errors,…

HFMA September 6, 2023

‘Concerns about access to care’ raised by OIG findings on prior authorization policies in Medicaid managed care

A year after highlighting problems with prior authorization in Medicare Advantage (MA), the HHS Office of Inspector General (OIG) has shined a spotlight on the same issue in Medicaid managed care. In the title of a new report, OIG says high rates of prior authorization denials by some Medicaid health plans “raise concerns about access…

Nick Hut August 1, 2023

How leveraging artificial intelligence in utilization management can enhance your revenue cycle

This white paper dives into how AI will help make healthcare sustainable and provide more of a focus on patient care. The goal is to decrease industry challenges and create new efforts to reduce the administrative cost of healthcare.

HFMA July 27, 2023
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