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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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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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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