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Category: Revenue Cycle Management

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March 23, 2020

How to Make Coordination of Benefits More Transparent and Truly Coordinated 

by Patrick | Healthcare Technology, Revenue Cycle Management

The Concept The concept behind coordination of benefits (COB) is fairly straightforward and simple. In situations where a patient has multiple health plans, it’s a way for commercial and government insurers to determine which payer is responsible for coverage, in what amount, and in what order — as a primary, secondary or tertiary payer.  For instance, two spouses may pay for health insurance under each of their employer’s plans, so each would be covered under their plan and their spouse's plan. Or a single person may have Medicare and additional health care coverage under a supplemental plan. Coordination of benefits… Read entire article here

November 18, 2019

Why Calculating Patient Financial Responsibility is the Key to Happier Patients and Increased Revenue

by Seth McCulloch | Healthcare Administration, Revenue Cycle Management

Healthcare is like any other service industry: provide the service, get paid. But unlike other service industries, a consumer (the patient) typically does not incur the cost of the service until weeks, months, or even years after it is rendered. Due to variations of inputs within a given visit or procedure and variables around payer contracted rates, the seller of the service (the doctor or provider) may not even know the cost of the service when it is rendered. Herein lies the problem. If a patient is unaware of how much is owed at the time he or she is… Read entire article here

September 23, 2019

Claims Denial Prevention in an Age of Prior Authorization

by Patrick | Healthcare Administration, Revenue Cycle Management

  The prior authorization process is a textbook example of the law of unintended consequences. Created for sound reasons — as a utilization management tool for healthcare insurance companies to control costs and protect patients from surprise bills —  it has unintentionally paved the way for a corresponding surge in administrative burdens, claim denials and rework. All of which have taken a toll on the revenues of healthcare providers. Not to mention the psyche of revenue cycle teams and patients.    The obvious answer to reducing claim denials and ensuing denial write-offs is to prevent them from occurring in the first… Read entire article here

September 16, 2019

Why Automation is the Key to Fixing Prior Authorization

by Patrick | Healthcare Administration, Healthcare Technology, Revenue Cycle Management

Prior Authorization: Concept vs Execution  To contain costs, health insurers and laboratory benefit managers (LBMs) rely on utilization management to introduce checks and balances that assess the appropriateness of a prescribed care regimen before authorizing it. The thinking behind this being that a less expensive option may be sufficient and that a stepped approach to patient care makes more financial sense than simply defaulting to the most expensive option.  To make utilization management work, payers and LBMs increasingly require providers to obtain prior authorization, a preemptive check to gauge the medical necessity and cost ramifications of a prescribed treatment and… Read entire article here