Insights

4 Tactics for Level of Care Denials Resolution and Prevention

Feb 28, 2023 8:00:00 AM / by Aspirion posted in Denial Management, clinical denials

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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 ...

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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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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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