by Christopher Baggot | Jul 21, 2023 | Aetna, Audits, Blog, CCMA, Claims, Clinical Medical Necessity Appeals, DRG Validation, Healthcare, HEDIS, Hospital Audits, Medicaid, Medical Records, RAC Audits, Revenue Cycle
Adoption of Cloud-based Solutions: As healthcare data volumes continue to grow exponentially; traditional data storage and management systems often struggle to keep pace. Cloud-based solutions offer virtually unlimited storage capacities and are easily scalable to...
by Christopher Baggot | Jul 19, 2023 | Aetna, Audits, Blog, Claims, Clinical Medical Necessity Appeals, DRG Validation, Healthcare, Hospital Audits, Medicaid, Medical Records, RAC Audits, Revenue Cycle
The healthcare landscape is riddled with complex processes, one of which is the clinical medical necessity appeal. Hospitals, healthcare providers, and patients can sometimes disagree with insurance company decisions about whether a particular service is medically...
by Christopher Baggot | Jun 12, 2023 | Aetna, Audits, Blog, CCMA, Claims, Clinical Medical Necessity Appeals, DRG Validation, Healthcare, Hospital Audits, Medicaid, Medical Records, RAC Audits, Revenue Cycle
The world of healthcare finance is replete with numerous challenges, and one of the most daunting is denial management. The labyrinthine structure of insurance claims processing, combined with the bureaucratic red tape and inefficiencies in healthcare systems, can...
by Christopher Baggot | Jul 9, 2019 | Aetna, Audits, Blog, CCMA, Claims, DRG Validation, Healthcare, HEDIS, Hospital Audits, Medicaid, Medical Records, RAC Audits, Revenue Cycle
Passive, Proactive, and Retrospective Cost Containment in Medical Auditing A case study analysis of services supplied to our hospital/provider clients By Christopher Baggott, CEO Medlinks Cost Containment, Inc. The great boxer Jack Dempsey said, “The best defense is...
by Christopher Baggot | Sep 13, 2018 | Aetna, Audits, Blog, CCMA, Medicaid, RAC Audits
The Medical Audit Common Reviews and their Risk The Healthcare Industry (both Payers and Providers) has always had a measure of audits and their “ripple effect” carries down the line whether it be workload i.e. record retrieval, desk auditing, refund request, data...
by Christopher Baggot | Sep 1, 2015 | Aetna, Blog
Many of you are familiar with Aetna’s denial based on CMS rule 2202.6. Here”s a recent response Medlinks provided to one of our clients. ABC Hospital Health System bills according to CMS guidelines and rules with no delineation between payers, either government or...
