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Don’t Let Medical Necessity Denials Ding Your Bottom Line

Payer denials, write-offs and claim rework can really hit a healthcare organization where it hurts the most – right in its bottom line.

Medical necessity is among the top-five reasons medical claims get denied, and those denials cost providers millions each year. In fact, medical necessity denials accounted for nearly 3 percent of all denials recorded in eSolutions’ TITAN performance insights tool, resulting in more than $8.9 billion in denied billed revenue since TITAN launched in 2011.

Healthcare Comparative Analytics and BI Solutions: What's the Difference?

Processing times, denial rates, cash flow and alternative payment models – all just a few of the many business challenges healthcare organizations face. As providers identify areas in which to focus their efforts and maximize performance, a growing number are investing in business intelligence (BI) solutions featuring comparative analytics. These solutions help organizations identify areas of the business in which improvements will offer the greatest ROI.

Battling Medicare Secondary Payer Claims

Medicare Secondary Payer (MSP) is the term used when Medicare is not the primary paying party. Heartache swirls around MSP claims for a variety of reasons, mainly because these claims are complex, need manual work and take the time from your busy billing team that it doesn't have.

Medicare Beneficiary Identifier: What Providers Need To Know

Medicare Beneficiary Identifier (MBI) has the attention of the entire healthcare industry. That's because Medicare is in the midst of launching a dramatic change. This spring, all Medicare beneficiaries will transition to a new Medicare identification system. Find out why that's a big deal in our latest white paper. 

How Advanced Claim Edits Lower Costs

A sure way to eliminate costs related to bad claims is to make sure they’re as clean and compliant as possible before they reach the payer. Incorrectly coded claims create waste – from processing, to follow up to managing appeals. It all adds up to higher administrative costs and increased A/R days.

Your Billing Software is Only Telling Half the Story

Don’t be fooled into thinking healthcare providers only need medical billing software to keep cash flowing. Like most things in healthcare, the billing cycle is complex, and it’s likely medical billing software is only telling half the story of your total billing cycle.

Bill Well and Prosper: Improving 3 Key Stages of Reimbursement to Make your Business Thrive

Navigating today’s dynamic healthcare billing and reimbursement climate can throw costly challenges at providers and their busy billing teams. Challenges like capturing accurate insurance data, timely claim submission, managing claim denials and rejections, handling review requests and audits. These issues and more contribute to reaching your number one goal of reducing days in A/R and getting more cash through the door.

The Life Cycle of a Medicare Claim

Solving the Biggest RAP Billing Issues

Home health agencies face more billing complexities than any other provider type. Agencies must ensure numerous tasks happen smoothly and precisely between the beginning of an episode to the submission of a Request for Anticipated Payment (RAP) through submitting a final claim. With heavy regulation, uncertainties and industry scrutiny, agencies are juggling many rules and extra steps to get paid.

Bill Well and Prosper - Claims Management and Business Intelligence

Step 3: Claims Management and Business Intelligence

So far in our Bill Well and Prosper blog series, we’ve outlined ways to improve your eligibility and claims submission process for a thriving business. You’ve done everything to secure reimbursement by confirming eligibility and maximizing clean, timely claims submission. Now what? It’s time to manage your claims and embrace robust business intelligence to take your organization and cash flow up a notch.