A claim could have been denied for many reasons, the question is, could any of them been prevented? Many claim denials are completely avoidable - and in fact, there are practical ways you can combat claim denials. Look at the following common claim denial reasons and see if any of them have happened to you recently:
When we talk about Accountable Care Organizations (ACOs) , a lot of people think that they are nothing more than a second try at the ol’ Health Maintenance Organizations (HMOs) of the late 80s. ACOs may have some things in common with HMOs, but when you look a little bit closer you’ll see that there are a few very distinct elements that differentiate them.
For many hospitals, the emergency room is the busiest place for both staff and patients. Overcrowding, long wait times and inefficient care plague a lot of U.S. hospitals and there is a growing need for solutions. Not only is the overutilization costing money, but it is affecting patient satisfaction scores, meaning that hospitals aren’t meeting their annual measures. Of course, there are times in the life of any emergency room, when it’s unavoidably busy: during summer months, hospitals that are in prime vacation areas need to plan for an influx of one-time patients. In the event of a disaster or outbreak of communicable illnesses in a community, utilization of emergency room services are certain to skyrocket. But what about in general, when physicians find that they are treating patients who, ultimately, do not need emergency services - meaning that patients who do are left in a lurch?
As part of BHM’s new partnership with The Doctor’s Channel, Anthony Grimaldi, BHM’s Senior Vice President Provider/Hospital Division, speaks about optimizing Pay-for-Performance models in healthcare. The Doctor’s Channel specializes in short, interesting video clips (generally 2 minutes or less) that educate doctors and other medical professionals on nearly any specialty imaginable. The vast video library also has many segments and series that are eligible for CME, making it an excellent resource for providers.
BHM Healthcare Solutions hosted its initial webinar in their ACO series August 1, 2014 on Succeeding as an ACO: A Guide to Transforming Your Organization. Anthony Grimaldi, Senior Vice President of BHM’s Provider / Hospital Division and Gwen Roberts, Senior Vice President of BHM’s Government / Payer Division were the keynote speakers. They delivered a riveting presentation focusing on issues in which providers, payers, pharmaceutical companies and states need to be aware, address, and implement in order to successfully transform to an ACO, while remaining viable, profitable, and successful.
With healthcare reform well under way, External Independent Review Organizations, (IROs) have become a requirement nationwide. For some, it’s a welcomed change to current strategies, but for other organizations, there might be a lot of unanswered questions about that transition, the motivation behind it and the necessity.
If you have a higher percentage of claim denials in your organization than you are comfortable with, you’re probably long over due for a close look at what is driving these denials up - and I hate to be the one to tell you, but it’s not the payers! Top 4 Reasons Why Your Claims are Denied Claims get denied for a variety of reasons - some of them are extremely simple to remedied, while others may require entire shifts in your organizational structure.
Understanding the revenue cycle can be tricky for many of us who work in healthcare. Unless we are directly involved with patient accounts, the subtleties of the process may be lost on us. That is, until we find ourselves patients - at which point even the most minute details of the process evident to us. If we want to get a clear view of the process in its entirety, and how we can improve at each step of the way, it’s often easiest to look at it as a continuous process which is always initiated by patient registration.
As part of BHM’s new partnership with The Doctor’s Channel, Mike Forrester, BHM’s Senior Vice President Independent Review Organization (IRO) Division, speaks about the amazing technology advancements that enable instant communication between clients, physician reviewers and BHM Healthcare Solutions.
In a healthcare setting, perhaps nothing is more valuable to leaders than a keen eye for negotiation. Obviously, successful negotiation techniques are largely dependent on the situation - and in healthcare, those situations often times are not small potatoes. Often, it's life or death.