As the healthcare industry grapples with various challenges, from workforce shortages to complex coding intricacies, embracing AI can empower revenue cycle professionals to envision a future with reduced denials, optimized revenue, and fortified financial health.
Here are six actionable steps healthcare organizations can take to reduce their likelihood of denials and write-offs.
This eBook, in collaboration with Care Logistics, details how hospitals and health systems can facilitate more effective decision-making by operationalizing elevated awareness.
Brian Gragnolati, CEO of Atlantic Health System, said that "there's a war going on between providers and payers right now." In his view, payers “are doing everything they can” not to pay providers for the care they deliver. He said insurers have greatly increased their rate of denials and are extremely reluctant to take on risk in value-based contracts.
The Labor Department recently sued UnitedHealth Group subsidiary UMR, alleging that it wrongfully denied claims for emergency room services and urinary drug screenings since 2015. UMR did not determine the medical necessity of the claims, denying them “based solely on diagnosis codes and not applying a prudent layperson standard," according to the complaint.
Hospitals and health systems, overburdened by pandemic-induced staff shortages, are in need of tech to improve workflows, reduce stress and save money. The claims denial process, which is a significant time suck and prone to errors, is ripe for innovation.