Denials are bad news for your revenue cycle. And research shows that unfortunately, denials happen more frequently than you might think. About 25-30% of all healthcare claims are rejected or denied. Each time a claim is denied, it means more staff resources, more time, and more financial resources are required to fix them.
Bundled payments have been a popular topic of discussion in the world of accountable care. In fact, some research shows that bundled payments and accountable care will make up two thirds of all payments by 2020. But the results of a study recently released by the RAND Corporation showed that as a payment model, bundled payments simply fell short.
The healthcare revenue cycle management environment is ever-changing, but continued advances in technology help healthcare professionals be more effective and efficient during each step of the process. Thanks to new software, increased portability, and a transition to electronic health records, ease of use is increasing swiftly.
The Medical Group Management Association actually put a price tag on the cost of managing each denial in your organization’s denial queue: $25-$30 a piece. That cost adds up when you consider that up to as many as a quarter of all claims get denied - meaning that for some hospitals, that $25 per claim price tag could become overwhelming pretty quickly. The first step in the case of any denied claim is determining why it was denied.
When we talk about healthcare spending being “out of control” does anyone ever say why? The Commonwealth Fund survey breaks down the costs of healthcare administration- which make up a quarter of all healthcare spending in the U.S.
When we talk about revenue cycle management systems it’s easiest to draw comparisons to physicians working in an ambulatory setting. This setting allows for accurate and timely charge capture of fees by their electronic medical record system. However, their inpatient counterpart physicians are less likely to reap the benefits of the EMR’s billing functions - if they’re reaping the benefits of an EMR at all.
FICO 9 | Medical Debt and Your Credit Score According to a statement made earlier this week by FICO, the company’s analytics are undergoing major changes that will affect the way medical debt is factored in to a person’s credit score. FICO 9 has arrived. How Does Medical Debt Affect Credit Scores? Credit scores are figured by looking at a person’s financial history, including any debts that they have accrued. In the United States, millions of Americans have medical debt, in some cases upwards of thousands of dollars, even though many are either privately or publicly insured. These debts, which were often the result of some unforeseen serious illness or injury, have traditionally had the potential to drastically lower one’s credit score.
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.
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.