Coverage denials based on medical necessity are far more likely to arise from Medicare FFS rules than from MA plan policies
Coverage rules stemming from Medicare national and local determinations were the most likely cause of claim denials in one Medicare Advantage plan.
HFMA’s new Premium Facilitated Learning courses combine self-directed study with facilitator feedback and time for peer problem solving
Learn more about HFMA’s Premium Facilitated Learning — a new line of courses — that combine self-directed study with expert facilitation in this Q&A with HFMA’s Sue Spear, director of Digital Learning and Todd Nelson, director of Partner Relationships.
How to unleash the true value of your remote reps using workforce management
A data-driven management approach to revenue cycle that empowers your staff could effect sweeping change for improved long-term financial health.
Hospitals and Congress propose improvements to prior authorization processes in Medicare Advantage
The American Hospital Association says pending regulations that would affect prior authorization should be expanded to include Medicare Advantage.
Healthcare News of Note: National index shows denials are up 11% since the onset of COVID-19
Healthcare News of Note for healthcare finance professionals is a roundup of recent news articles: Denials are up since the onset of COVID-19, nonprofit hospitals’ community investing falls short, and pediatric clinicians use the EHR less than other clinicians.
UnitedHealthcare reverses course on new approach to emergency department claims, but perhaps only temporarily
UHC had announced this week that it would evaluate claims starting July 1 to determine whether ED visits were for emergent or nonemergent events.
Looming UnitedHealthcare policy on coverage of emergency department care draws opposition from hospitals, physicians
In a move strongly opposed by provider associations, UnitedHealthcare soon will start denying coverage of ED care that it deems to have been nonemergent.
2 proven strategies that can help healthcare providers reduce denials and strengthen their revenue cycle
Healthcare providers should consider the use of two proven strategies to reduce claim denials: Maximize reps follow up ability and close the gap between the front end and back end with a continuous feedback loop.
Inside HFMA: It’s time for healthcare providers to standardize denials performance measurement
HFMA’s Claim Integrity Task Force, in collaboration with business partners, set out to scope and define metrics that could be adopted industrywide for benchmarking.
New HRSA funding is available to providers that administer the COVID-19 vaccine and don’t receive full payment from a health plan
The Health Resources and Services Administration announced a new program to reimburse healthcare providers for administering COVID-19 vaccines to patients whose health plans either do not cover vaccination fees or require cost-sharing.