PCH Health

Did you know that healthcare claim denials are costing hospitals and health systems a staggering $19.7 billion every year? As we gear up for 2025, new trends in claim denial management are reshaping how healthcare organizations tackle revenue cycle management. Here’s what you need to know: - AI is a game changer: No longer just an option, AI is revolutionizing denial management. Payors are using AI to cut costs, and providers are following suit. These smart tools can spot denial patterns, enhance coding accuracy, and proactively mitigate denial risks. - Pre-approvals aren’t foolproof: Despite getting pre-approval, nearly 15% of commercial claims still face denial. There’s a growing demand for standardized guidelines and streamlined workflows to tackle this issue head-on. - Increased scrutiny on high-cost treatments: Treatments involving pricey drugs and complex diagnoses are under the microscope. Having clear justifications and thorough documentation is more important than ever. - Regulatory changes are influencing denials: Agencies like the OIG are zeroing in on specific billing areas, such as sepsis and diabetes treatments, which is impacting denial trends. - Coding errors are costly: With 56% of coders failing audits in 2024, accurate documentation and collaborative auditing platforms have become critical to reducing denials. Want to dive deeper into denial management? Click here to connect with our experts: https://lnkd.in/dm5KbPGE #MedicalCoding #RevenueCycleManagement #Healthcare #MedicalBilling #HealthcareTechnology #Insurance #Claims #RevenueCycle

Does your RCM team truly give you the tools to tackle challenges head-on? Staying ahead of compliance and revenue risks isn’t just a must—it’s a strategic edge. Here is how outsourcing helps and what you should look for while outsourcing RCM services. Here are three core competencies to prioritize: - A top provider compares your performance against industry standards, helping you spot outliers, assess progress, and apply insights to improve continuously. - They proactively anticipate compliance and revenue issues, allowing you to allocate resources more effectively where they’re needed most. - They keep up with policy shifts to minimize denials, maintain compliance, and support steady revenue flow. With these strengths, your RCM solution shifts from reactive to proactive—driving efficiency, sustainable growth, and a healthier bottom line. Want to learn more about RCM outsourcing? Click here: https://lnkd.in/dryhM8_4 #MedicalCoding #RevenueCycleManagement #Healthcare #MedicalBilling #HealthcareTechnology #Insurance #Claims #RevenueCycle

A 30% increase in collection efficiency—that’s what healthcare providers can achieve even if they have a skilled staff shortage. Practices can overcome common challenges like documentation loss, manual errors, ineffective insights, and difficulties with optimization while working with staff that lacks the desired skills. Here’s how you can streamline your processes in the absence of skilled staff: - Leverage a unified portal to download and access staff information easily - Digitize incoming documents to extract information efficiently - Integrate your new portal seamlessly with existing EHR systems - Utilize advanced analytics and reporting for better decision-making Want to see these steps in action? Learn how a top US provider collected $4.3 billion in net revenue. Read the full case study here: https://lnkd.in/dVG4HMAt #MedicalCoding #RevenueCycleManagement #Healthcare #MedicalBilling #HealthcareTechnology #Insurance #Claims #RevenueCycle

Prior authorization inefficiencies are costing healthcare an astounding $1 trillion annually in administrative expenses. It’s not just providers who are feeling the weight—payers, too, are burdened by the complexities of prior authorization. By following these steps, payers can streamline the prior authorization process and reduce these costly challenges: - Receive and review requests efficiently - Implement automated and manual task reviews - Ensure timely decision-making - Communicate decisions clearly with providers - Process post-authorization claims seamlessly Want to dive deeper? Connect with our experts here: https://lnkd.in/dm5KbPGE #MedicalCoding #RevenueCycleManagement #Healthcare #MedicalBilling #HealthcareTechnology #Insurance #Claims #RevenueCycle

Did you know that healthcare providers are seeing a 32% reduction in AR days thanks to RCM automation? From 2024 to 2025, we’re about to witness a major shift in how accounts receivable is managed—where error-free processes, faster cash flow, and lower operational costs become the new normal. Here’s how businesses can automate and revolutionize AR management in 2025: - Automated invoice processing - Automated payment reminders - Dynamic credit scoring - Auto-reconciliation - AI-powered collections - Workflow automation Ready to embrace the future of AR management? Drop a comment and we’ll personally guide you through the automation process! #MedicalCoding #RevenueCycleManagement #Healthcare #MedicalBilling #HealthcareTechnology #Insurance #Claims #RevenueCycle

Client satisfaction is our utmost priority! We're committed to delivering comprehensive RCM services tailored for our clients. By seamlessly integrating cutting-edge technology with human expertise, we create customized solutions that address the unique needs of every client. Ready to elevate your organization's success? Click here: https://lnkd.in/dm5KbPGE #MedicalCoding #RevenueCycleManagement #Healthcare #MedicalBilling #HealthcareTechnology #Insurance #Claims #RevenueCycle

According to the Kaiser Family Foundation, 18% of healthcare claims get denied, underscoring the need for an efficient claims adjudication process. Do you feel overwhelmed by the daily volume of claims? We’ve got you covered! Master the claim adjudication process with these steps. Need more insights? Let’s simplify it together—reach out today! https://lnkd.in/dm5KbPGE #MedicalCoding #RevenueCycleManagement #Healthcare #MedicalBilling #HealthcareTechnology #Insurance #Claims #RevenueCycle

Did you know the data interoperability market is projected to grow at a 9.5% CAGR, hitting $3.5B by 2025? This growth highlights the critical role of interoperability in healthcare RCM. Here’s why RCM interoperability matters: - Faster claims processing - Improved accuracy - Better patient care coordination - Reduced administrative burdens Without it, providers face data silos, duplicate entries, delays in claims processing, denial challenges, and more. Curious about RCM interoperability and how it can transform your operations? Dive into our latest blog, covering everything from challenges to strategies and benefits. Click here to learn more: https://lnkd.in/gf8R-Bdx #MedicalCoding #RevenueCycleManagement #Healthcare #MedicalBilling #HealthcareTechnology #Insurance #Claims #RevenueCycle

A staggering 70% of revenue cycle challenges stem from billing and coding errors. For ASCs, mastering effective billing and coding is crucial to securing timely reimbursements and maintaining financial health. Here are some steps to optimize your medical billing and coding. By following these steps, ASCs can navigate the complexities of revenue cycle management more effectively. Need more support with billing and coding? Connect with us! We can help elevate your operations and improve your bottom line. Click here to learn more: https://lnkd.in/dcMt92tr #MedicalCoding #RevenueCycleManagement #Healthcare #MedicalBilling #HealthcareTechnology #Insurance #Claims #RevenueCycle

Even a 2-3% drop in denial rates can have a big impact on a healthcare provider's cash flow. Now, imagine cutting denials by over 30%. How do you make that happen? Here are key strategies to reduce denials and increase your cash flow: Find More Active Insurance: Automate real-time insurance validation for clear, billable transparency. This will lead to fewer denials and faster claims processing. Work by Exception: Prioritize high-probability claims and leverage claim-monitoring tools to avoid wasted time on unappealable denials. Arm Managers with Data: Provide your leadership team with real-time denial and write-off data to identify root causes and shift towards prevention strategies. Hold Payers Accountable: Use payer scorecards and data insights to highlight discrepancies and renegotiate contracts that protect your financial interests. You can transform your denial management process by incorporating intelligent automation and data-driven strategies. Want to learn more about denial prevention? Connect with our experts today: https://lnkd.in/dm5KbPGE #MedicalCoding #RevenueCycleManagement #Healthcare #MedicalBilling #HealthcareTechnology #Insurance #Claims #RevenueCycle