Key takeaways: Experian Health’s State of Claims 2025 report is out now, detailing providers’ views on claims management and how these have changed since the survey began in 2022. Claim denials are still on the rise, causing providers to find faster and more efficient ways to submit clean claims the first time. When it comes […]
Key takeaways: Manual work and disconnected claims management systems are often error-prone, resulting in delayed and denied claims. Technology, like automation and AI, can help healthcare organizations predict and prevent potential claims issues before submission. Implementing AI-powered claims management solutions should be a top priority for revenue cycle leaders. Healthcare claims denials are on the […]
TABLE OF CONTENTS Challenge: OhioHealth faced rising denials Solution: AI + machine learning to check eligibility Outcome: Patient Access Curator reduces denials What’s next: OhioHealth’s next steps “Registrars used to wonder, ‘Do I run Coordination of Benefits? Which insurance is primary?’ Now Patient Access Curator does all that work and removes the guess work, and […]
Since 2017, CDC has been committed to protecting patients and addressing sepsis, a life-threatening medical emergency that affects at least 1.7 million adults each year. This Sepsis Awareness Month, CDC ushers in a new chapter in advancing sepsis programs and patient care: New Innovative Tools and Scientific Work CDC has led the way providing new, […]
The healthcare technology landscape is constantly evolving, and a crucial question emerges: are established EHR systems, like EPIC, at risk of becoming outdated if they don’t adapt to changing needs and technological advancements? Disruptions have occurred in the past. Blockbuster, once a leader, didn’t adapt to streaming and declined. Netflix embraced innovation and succeeded. This […]
Palmetto GBA has also released the latest data for Q4 2024 on the most common hospice claim denial codes. These findings are essential for hospice providers working to maintain compliance and ensure proper reimbursement under Medicare. Top Denial Codes for Hospice Claims: Agency Recommendations: Staying compliant not only speeds up reimbursement but also prevents potential […]
Palmetto GBA has published its quarterly summary of the top denial reason codes for home health agencies (HHAs) for Q4 2024. These denial reasons offer insight into common compliance pitfalls and documentation errors that directly affect claim approvals and agency cash flow. Top Reasons for Denials in Home Health Include: Each of these denial codes […]
As 2025 unfolds, significant updates to HIPAA regulations are on the horizon, with sweeping changes aimed at increasing patient access to health data while tightening data privacy and security protocols. Healthcare providers should prepare for these changes now to avoid compliance pitfalls and potential financial penalties. The U.S. Department of Health and Human Services (HHS) […]
On February 14, 2025, the Centers for Medicare and Medicaid Services (CMS) stopped introducing the Hospice Special Focus Program (SFP) to conduct a more thorough assessment. This break is a necessary step to recognize that the program is not achieving its intended goals in its current format. The hospice community has long supported strong patient […]
A new regulation has been released regarding Medicare Advantage plans. If you are providing home health services to a patient enrolled in a Medicare Advantage plan, you are now required to issue the Notice of Medicare Non-Coverage. This notice must include information about the BFCC-QIO, allowing patients the opportunity to appeal decisions related to their discharge. […]