by Christopher Baggot | Jul 24, 2023 | Blog, Claims, Healthcare
The current healthcare landscape presents a sea of financial complexity where billions of dollars in claim denials are processed each year. In 2023, it is estimated that these healthcare denials will amount to $120 billion in the United States. These figures are...
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 | Nov 14, 2022 | Blog
Check out Becker’s article showing industry losses due to denials. We can help. Many hospitals and health systems are facing their toughest financial year in decades as they simultaneously address revenue and expense issues, with rising costs, payer denials...
by Christopher Baggot | Oct 6, 2022 | Audits, Blog, Claims, Clinical Medical Necessity Appeals, DRG Validation, Healthcare, Hospital Audits, Medicaid, Medical Records, RAC Audits, Revenue Cycle
Medical Appeal Case Study Clinical Appeals Case Study Challenge The client is suffering under an “onslaught” of denials and while struggling to keep up, they also would like to understand the exact reason for the denials and their fiscal impact on the client. Solution...
