Thanks to the recent Georgia Supreme Court ruling in Bowden v. The Medical Center (TMC), Georgia hospitals are free from the fear that filing a hospital lien at their chargemaster rates will result in a claim against them for fraud and negligent misrepresentation by a class or an individual uninsured patient. The ...
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When dealing with motor vehicle accident (MVA) claims, the collection rate on third-party liability can be substantially higher than any other payment source—particularly involving patients who have no form of health insurance. Whether managed in-house or outsourced, third-party liability (TPL) programs often generate ...
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Since the global outbreak of the novel coronavirus, many health systems have seen a decline in normal patient services, leaving gaps in revenue. In light of the national public health emergency, Congress has passed legislation designed to support both citizens and hospitals during the pandemic—but without a thorough ...
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In a recently released Care Decision Insights, Humana announced that 145 formerly inpatient-only procedures are now approved at the outpatient level of care. According to Humana, the Centers for Medicare and Medicaid Services (CMS) says that its current inpatient-only list applies to traditional Medicare–but not ...
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Patient access teams are the face of your facility. These staff members must ask the right questions, gather accurate information, and establish trust with patients from all walks of life. If hospital staff cannot provide answers or proper assistance, patients become frustrated and confused. The key is informed, ...
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Even before the outbreak of the novel coronavirus, workers’ compensation claims posed significant challenges for healthcare facilities. If a work-related illness or injury is overlooked initially—whether because the PAS misses it or the patient does not sufficiently disclose information—the patient’s primary insurance ...
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Some of the top challenges affecting health systems’ reimbursement involve physician credentialing and provider enrollment. Enrollment with various payors in multiple states can be a tedious process—and few hospitals are staffed sufficiently to onboard, credential, and enroll new providers. Facilities must also ensure ...
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After a 2014 scandal uncovered long wait times and insufficient care from VA facilities, Congress passed legislation that expanded veterans’ access to healthcare and enabled them to visit non-VA hospitals for treatments. However, even though the Department of Veterans Affairs was supposed to pay as a secondary payor ...
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Especially for facilities near state borders, out-of-state Medicaid claims can cause huge headaches. Many hospitals just consider it write-off business. But this outlook leaves millions of unclaimed dollars on the table—and we can help you get that revenue back. This case study illustrates our commitment to seeing ...
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Approximately 5-10% of medical billing claims are rejected each year. These claims are extremely expensive to rework, requiring resubmissions and hindering productivity. To maximize income, facilities must start by identifying how their denials are holding them back. Our white paper gives you four simple tips on how ...
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