Inpatient readmissions and length of stay claim denials are major issues in the healthcare industry. When a patient is readmitted to an acute care hospital within a certain period of time following the hospital discharge—typically within 30 days—it can lead to a claim denial by the insurance company. Similarly, if a ...

As revenue cycle management experts, we're always looking at the broad picture of denied accounts placed with Aspirion to see where there is an uptick in payer denials. One area of uptick relates to level of care denials. Although hospital Utilization Management (UM) teams are requesting inpatient authorization as ...

Excerpts from RCM Fireside Chat with Kimberly Scaccia, VP of Revenue Management at Mercyhealth Systems, and Ben Gleason, VP of Sales at Aspirion

Healthcare organizations face a growing list of cybersecurity challenges, including compromises to system integrity, threats to patient data privacy, and distributed denial of service (DDoS) attacks that disrupt a provider’s ability to deliver patient care.

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.

On July 6, 2022, the Arizona legislature passed 2022 Ariz. SB 1021 regarding hospital 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 ...

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 ...

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. ...

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 ...

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 ...