Denials and Appeals

Q&A: Implementing processes for denials management

Fri, 06/09/2023

Denials and Appeals, Policies and Procedures, Revenue Integrity

Q: What processes or systems do you have in place for managing denials?

2023 State of the Revenue Integrity Industry Survey Report

June 2, 2023

Billing and Claims, Chargemaster and Charge Capture, Compliance, Denials and Appeals, Monitoring and Audits, Payer Contracting, Policies and Procedures, Program Management, Reimbursement and Payment Methodologies, Revenue Integrity

NAHRI is celebrating the sixth annual Revenue Integrity Week (June 5–9) to acknowledge and raise awareness of the invaluable contributions of revenue integrity professionals in the healthcare industry. With the 2023 State of the Revenue Integrity Industry Survey Report, NAHRI is taking an in-...

Prior Authorization for Hospital Services: Utilization Control or Compliance Initiative?

Fri, 06/02/2023 - 16:38

Webinars

Billing and Claims, Coding and Documentation, Compliance, Coverage, Denials and Appeals, Policies and Procedures, Program Management, Revenue Integrity

Kimberly A. Hoy, JD, CPC, covers the ins and outs of the prior authorization program for hospital outpatient services.

Medicare Advantage and the 2-Midnight Rule: Level the Field With Medicare Advantage Payers

Fri, 06/02/2023 - 16:35

Webinars

Billing and Claims, Coding and Documentation, Compliance, Coverage, Denials and Appeals, Monitoring and Audits, Payer Contracting, Policies and Procedures, Program Management, Revenue Integrity

Jerilyn Morrissey, MD, clears up confusion about the regulations and explain how to determine when the 2-midnight rule applies to Medicare Advantage payers.

Report finds that commercial insurers issue more denials, take longer to pay than Medicare

Wed, 05/31/2023

Revenue Integrity Insider

Billing and Claims, Denials and Appeals, News, Payer Contracting, Reimbursement and Payment Methodologies

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.

OIG: MAO prior authorization denials raise concerns

Wed, 05/17/2023

Revenue Integrity Insider

Denials and Appeals, Monitoring and Audits, News

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.