Although commercial payers typically pay more per claim, it is significantly easier for providers to get reimbursed by Medicare, according to a May 2023 Crowe Revenue Cycle Analytics report.Read More »
The Office of Inspector General (OIG) recently released an audit report on prior authorization and payment denials by Medicare Advantage Organizations (MAO). The result raised OIG concerns about certain MAO denial practices impacting beneficiary access to medically necessary care.Read More »
While some people choose to manage denials by using “zone defense,” others opt for a targeted approach. “My denials team works by payer,” says Frank Cantrell, CHRI, corporate director of revenue integrity at Penn Highlands Healthcare in DuBois, Pennsylvania. “They know their...Read More »
