Traditional methods of claims processing are time-consuming, error-prone, and costly. Artificial intelligence (AI) has emerged as a transformative technology, reshaping how medical claims are processed and setting new standards for efficiency, accuracy, and cost-effectiveness.
Revenue cycle management (RCM) stands as the linchpin that determines the financial vitality of healthcare organizations and payers alike. We will delve into proven strategies tailored specifically for healthcare organizations and payers to streamline and accelerate their revenue cycle.
Collaboration between healthcare providers and payers is instrumental in navigating the complexities of medical necessity criteria. By fostering a cooperative environment, both parties can work together to ensure that medical decisions align with the best interests of the patient.
Efficient revenue cycle management (RCM) is the linchpin that ensures a healthcare organization's financial health. In this article, we will explore the ins and outs of revenue cycle management, discuss its significance, and provide strategies to master this critical aspect of healthcare administration.
The healthcare industry has embraced a collaborative approach that is gaining significant traction—physician peer-to-peer reviews. In this comprehensive exploration, we will delve into the significance of physician peer-to-peer reviews, their role in enhancing healthcare, and how they strengthen the bonds within the medical community.
Physician advisor (PA) reviews play a crucial role in improving patient outcomes by facilitating various processes within healthcare organizations. PAs act as liaisons between hospital administration, clinical staff, and support personnel to ensure compliance with regulatory issues, advise physicians on medical necessity, and help achieve overall organizational goals related to the efficient utilization of healthcare services. Physician advisors contribute to better patient outcomes through several key activities.
To understand claim denials affecting reimbursement requires data. In healthcare, claim denials occur when an insurer or payer refuses to reimburse a healthcare provider for a particular medical service or treatment. Claim denials can occur for a variety of reasons, such as inaccurate or incomplete billing information, lack of medical necessity, or failure to follow the proper billing procedures.
Independent peer review plays a crucial role in revenue cycle management for the healthcare industry. Revenue cycle management (RCM) refers to the process of tracking patient care from registration to final payment, including all the administrative and clinical functions that contribute to the capture, management, and collection of patient service revenue.
Top At-Risk Conditions and utilization spikes that healthcare leaders and stakeholders across the industry must prepare to proactively address in the upcoming year highlight the recently released, 2023 State of Health – In The Aftermath Report. The report also presents predictive findings and explores the top contributing factors of many utilization increases.
In 2015, cancer deaths cost the U.S. $94 billion in lost earnings, according to a study published in JAMA Oncology.