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 »
CMS released a proposed rule on December 6 to promote transparency, efficiency, and automation in prior authorization processes. Certain requirements in the proposed rule are also intended to improve data accessibility for patients, providers, and payers.Read More »
It’s helpful to understand payer-specific contract terms and government billing requirements when developing work lists or work queues and reports. Analyzing data that comes from claim scrubber edits, return to provider edits, variances, and denials can provide insight into repetitive issues...Read More »
