In a study of 239 hospitals under the Medicare program, Hsia et al. identified the rate of DRG coding errors to be 20.8%, of which 61.7% significantly favored the hospital. Discrepancies between the s...
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Changing laws and regulations can make it difficult for organizations to keep up with healthcare compliance and noncompliance can lead to serious consequences. A compliance audit helps evaluate streng...
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Precise clinical documentation is integral to every patient encounter, as it assists providers to make informed decisions for patient care, helps assess clinical quality and determines appropriate rei...
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The HCC model assigns a Risk Adjustment Factor (RAF) score to each patient basis patient’s demographics and diagnoses, which is a relative measure of how costly that patient is anticipated to be. Acco...
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By virtue of ever-changing dynamics of regulatory standards in relation to compliances of DMEs, billing and reimbursement for these pose specific challenges for providers. With huge demand of DME in t...
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October 2021 report in Becker’s hospital reviews studied $100 billion worth of denials and $2.5 billion in audited claims to assess reason why payers denied hospital claims over coding issues. The top...
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The Change Healthcare 2020 Denials Index which is an analysis of 102 million hospital transactions valued at $407 billion in total charges across more than 1,500 U.S. hospitals, reports the average me...
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Missing or Invalid Claim Data is a significant cause of claim denial that accounts for about 17.2% of all denials. Clean claims without errors and with accurate coding are the only ones which get tran...
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Incorrect payment posting affects the entire revenue cycle. If payment posting is incorrectly done by the team, the balance of the paid account still reflects in the system and the AR team spends unne...
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“Days in AR” is the first measure of the overall performance of your accounts receivable efforts. The following figures are looked as benchmarks for medical billing and collections: 30 days or less...
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A transparency data released in 2020 by the Centers for Medicare and Medicaid Services (CMS) to examine claims denials and appeals among issuers from plan years 2018 and 2019 also reports about 17% of...
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