Insights

Mounting prior authorization denials worsen hospital-payer relations

Nov 21, 2022 11:31:34 AM / by Aspirion posted in Patient Experience, Denial Management, Outpatient Care, Inpatient Care, clinical denials

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Prior authorization requirements have been around for decades, and frustration from providers is nothing new. But a new report suggests that abuse of these policies is compounding hospitals’ already cratering finances and pushing relations with health insurers to the brink.

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Arizona Lien Laws Amended to Limit Future Lien Recovery Amounts

Sep 8, 2022 1:08:54 PM / by Aspirion posted in Liens, Denial Management, Revenue Cycle Management

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On July 6, 2022, the Arizona legislature passed 2022 Ariz. SB 1021 regarding liens for healthcare treatment and transportation of an injured person. The bill is effective September 24, 2022, amending A.R.S. § 33-931 and adding A.R.S. § 33-937. This article discusses the changes that hospitals should be aware of ...

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Artificial Intelligence Powering Healthcare Innovation

Jan 27, 2022 10:03:32 AM / by Aspirion posted in Patient Experience, Reimbursement, Veterans Affairs, Denial Management, Complex Claims, VA Claims, Workers' Compensation, Third-Party Liability, Revenue Cycle Management, Artificial Intelligence

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Whether we notice it or not, organizations of every kind utilize artificial intelligence (AI) in their everyday processes. AI is artificial intelligence presented by a machine powered by algorithms built from statistical, machine learning, and deep learning techniques to replicate human intelligence. AI uses data to ...

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Leveraging ERISA in overturning denied medical claims

Oct 11, 2021 8:31:14 PM / by Aspirion posted in Complex Claims, ERISA

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The Employee Retirement Income Security Act of 1974 (ERISA) is a federal law that, in part, enables beneficiaries to appeal any covered insurance claim to request payment in full. Sounds simple, but it’s not. ERISA is a complex set of laws, and one article definitely won’t provide a definitive process to follow. ...

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3 Tips to Boost Medical Predetermination Submission Success

Aug 31, 2021 8:00:00 AM / by Aspirion posted in Denial Management, Complex Claims

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Many times, payers deny specific patient treatments, drugs, or hospital stays due to the specific treatment or drug being considered non-covered or experimental. While these claim denials can be argued in a formal appeal on the back end, a health system can also obtain a predetermination for these treatments and drugs ...

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UHC sepsis-related changes to know

Jul 7, 2021 3:13:09 PM / by Aspirion posted in Denial Management, Complex Claims, clinical denials

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Beginning July 1, 2021, United Healthcare (“UHC”) will begin reviewing Medicare Advantage and commercial claims for sepsis-related treatment on a pre-payment basis and post-payment basis. Previously, UHC only reviewed sepsis-related claims on a post-payment basis. Payer policy changes, such as this, can have a lasting ...

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Are Your Accounts Receivable Numbers Accurate?

Jan 13, 2021 11:00:00 AM / by Aspirion posted in Reimbursement, Complex Claims

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The Accounts Receivable numbers on most hospital balance sheets are inflated. To give your organization’s finance executives accurate revenue expectations, you must ensure that your receivable is as accurate as possible. Here are three areas where revenue cycle professionals can upgrade their procedures to maximize ...

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New Law Impacts COVID-Related Reimbursement

Jan 6, 2021 9:15:00 AM / by Aspirion posted in Reimbursement, Workers' Compensation, COVID-19

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Near the end of 2020, New Jersey Governor Phil Murphy signed Senate Bill 2380 into law, establishing that essential workers’ contraction of COVID-19 during the Public Health Emergency is considered work-related and fully compensable for the purposes of workers’ compensation. This law applies to any individuals who ...

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Price Transparency: What You Need to Know in 2021

Oct 28, 2020 9:18:00 AM / by Aspirion posted in Price Transparency, Centers for Medicare and Medicaid Services

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In an effort to improve the patient experience, the healthcare industry is implementing new regulations and expectations regarding price transparency. As part of the new requirements, the Centers for Medicare and Medicaid Services’ (CMS) Price Transparency Final Rule will require hospitals operating in the U.S. to ...

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Georgia Supreme Court Rules in Favor of Georgia Hospitals

Sep 30, 2020 9:08:00 AM / by Aspirion posted in Liens, MVA Claims, Georgia Supreme Court

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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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