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 ...

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 ...

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 revenue integrity, facilities must start by identifying how their denials are holding them back. Our white paper gives you four simple ...