Insights

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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Ensuring Reimbursement Through Effective Appeals

Jul 8, 2020 10:23:10 AM / by Aspirion posted in Denial Management, Complex Claims

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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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