Medicare Advantage Organizations (MAO) sometimes inappropriately delay or deny beneficiaries’ access to medically necessary care, according to a recent OIG report. The OIG conducted a study and found that Medicare Advantage beneficiaries were denied access to services such as advanced imaging services and postacute facility stays.
The agenda for the 2022 Revenue Integrity Symposium (RIS) has been released. The event, to be held September 19–20 at the Hilton Phoenix Resort at the Peak in Phoenix, Arizona, will feature two educational tracks covering essential revenue integrity education, updates, and thought leadership.
Without gathering and analyzing all the necessary data and knowing the source of the leakage, the organization is hamstrung when it comes to preventing future denials. Learn how electronic remittances can be analyzed to provide data.
Turning a traditionally managed healthcare organization into a revenue integrity focused organization requires planning, dedication, resources, and leadership. With the right team and the right technology,...
Dealing with denied claims is an inherent part of healthcare billing. Although having a plan to address denied claims is a high priority, implementing a plan to reduce the number of denials is just as important. Doing more work up front in the healthcare billing process reduces the amount of re-work needed on the back end.
Q: We are experiencing post-payment audits that result in denials of inpatient claims. Our coders and CDI leaders are vehement that the patient meets MCG and/or coding guidelines, but the payer is using clinical results from the patient as their justification. It seems as if they are ignoring all established guidelines. If these are inappropriate denials, how do we fight them?
Although the diagnoses most often targeted for denials remain familiar, payers’ denials reasons and strategies are constantly evolving. Use fresh approaches and real data to address and avoid denials.
