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 | 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...
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 | Nov 9, 2018 | Audits, Blog, Claims, DRG Validation, Hospital Audits
Defense for Claim Sweeping of “Routine” Supplies Recently a hospital client asked us to review claims where the supply items had been removed from the claim. In response to the request, we found the health plan had “swept” a few particular revenue centers, claiming...
