Denial Management

Of course, the best way to handle claim denials is to prevent them in the first place. That’s why this recent list of denial prevention strategies from Becker’s is something no denial manager should miss. We believe though that it has a problem. Boiling down denials to a list like this obscures the fact that…

Becker’s announcement on CMS’ DME prior authorization rule came a while back, but CMS’ stance on prior authorization is likely still causing denial issues for your facility today. The Backstory Just as 2016 was about to round the corner, CMS issued a rule requiring prior authorization before Medicare would reimburse DME that had been found…

A recent report from Grand View Research reveals a potentially hidden threat to telemedicine programs. We’re all aware that chronic disease is a growing problem around the world, but did you know that the diabetic foot ulcer treatment market alone is valued at over $3.15 billion?  Statistics like that mean the results of a report…

Earlier this year, The Huffington Post reported on the largely negative impact Medicare regulations are having on CPAP users and providers. On the provider side specifically, CPAP denials have been known to top denials lists for HME and DME suppliers, meaning that understanding the layers of Medicare’s logic is the first step in understanding how…

The CHANGE HEALTHCARE HEALTHY HOSPITAL REVENUE CYCLE INDEX estimates that out of the $3 trillion in claims that were submitted in 2016, 9 percent ($262 billion in charges) were initially denied. For your average health system, that adds up to as much as 3.3 percent of NPR, dinging them for an average of $4.9 million…

It looks like 2018 is going to be the year of denials and that’s exactly as foreboding as it sounds. Becker’s article based on the Advisory Board’s survey revealed that denials written-off as uncollectable, costs the average 350-bed hospital $3.5 million annually; a whopping 90 percent jump from just six years prior. Compounding this challenge…