Greenway Health’s Post

Navigating insurance claims and reimbursement processes can be challenging, but understanding key strategies can streamline the experience for both patients and providers. From knowing your coverage details to preparing accurate documentation and following up on claims, this guide offers essential tips to make the process more efficient and reduce stress. Explore how you can avoid common pitfalls and ensure smoother reimbursement experiences. Read the full article here: https://lnkd.in/dNm5-nGG

Authorized inpatient stay audited after claim submission? Many plan types have prohibitions on the retraction of prior authorizations. We've posted previously on Medicare Advantage rules that are clear prior authorized services cannot be denied later due to medical necessity, even if a plan describes the review as a "payment" review. Missouri utilization review laws also protect against plans retracting prior authorizations by plans covered by state law. Authorized cannot be denied or have payment reduced unless the authorization was made based on material misrepresentation or omission, or termination of coverage. In addition to contract rights, you may have remedies available through the Department of Insurance: https://lnkd.in/gb-Gf4M7 20 CSR 400-10.200

Insurance Denials: The Silent Revenue Killer and How to Combat Them As a #medicalprovider, you've likely experienced the frustration of #insurancedenials. They seem harmless at first but can slowly drain your practice’s revenue if not addressed effectively. 🚨 Did you know? Nearly 10% of #healthcare claims are denied on the first submission, and more than 60% of those denials are never resubmitted! But here’s the good news: #DenialManagement is not just about fixing errors—it’s about implementing proactive strategies to prevent them. 🔑 Key steps to combat denials: Accurate Documentation: Ensuring thorough and precise coding from the start can significantly reduce denials. Proactive #FollowUp: Monitoring claims and responding quickly to denials or rejections keeps the revenue cycle moving. Understanding Denial Trends: Analyzing common denial reasons can help you address recurring issues and avoid future pitfalls. Patient #EligibilityVerification: Double-checking patient insurance details upfront to prevent eligibility-related denials. At the end of the day, a streamlined denial management process means less revenue loss and more time focused on patient care. If you're ready to regain control over your #practice’s revenue cycle, let's connect! I help medical providers turn #denials into paid #claims and improve #financial outcomes.

🚫 Tired of the never-ending cycle of denied claims? 🚫 If denied insurance claims are causing more headaches than your toughest cases, you're not alone. 😖 But the good news? You can break the cycle and reclaim your revenue! 💸💪 Check out my latest blog article: "Stop the Denial Cycle: Expert Tips Every Doctor Needs to Know" and discover: ✅ Why minor errors are costing you BIG ✅ The necessary evil of prior authorizations (and how to handle them) ✅ Timely filing tips so your claims don’t expire before they’re even reviewed ✅ The magic of appealing denials (yes, you can fight back!) ✅ Why outsourcing your billing might be the best decision you’ll ever make Let’s stop the denials and get your practice back on track! 🙌 Read the full article here: https://lnkd.in/e7PUDYUA #MedicalBilling #PracticeManagement #DeniedClaims #RevenueCycle #Healthcare #MedicalPractice #DoctorLife

Post-service denials of claims when care was prior authorized is an increasingly common occurrence. Monitor MA plans and state-law governed exchange and fully insured plans for instances of denying or lowering payment on authorized services. In addition to your contract procedures, there are reporting mechanisms under both state and federal agencies that monitor plan activities.

Today's NY Times article sheds light on some questionable practices of some of the largest insurance companies in the US for out-of-network claims and the negative impact on patients. The article discusses how Multiplan partners with other insurers to make millions in fees on out-of-network claims, ultimately burdening patients with exorbitant medical bills. This has a real impact on the overall well-being of their members and beneficiaries, both clinically and financially. Read the article here: https://lnkd.in/gVxGkbs4

Did You Know Not Verifying Coverage Can Hurt Your Practice? 🚫 Failing to verify insurance coverage upfront can lead to denied claims, delayed payments, and financial losses for your healthcare practice. Here’s how to avoid it and keep your revenue cycle running smoothly: Why Verification Matters: 1 - Avoid Denials: Insurance coverage can change, and submitting claims without verification can result in costly denials. 2 - Reduce Delays: Verifying coverage ensures all required information is accurate, speeding up the claims process. 3 - Better Patient Experience: Patients appreciate knowing what their insurance covers ahead of time, preventing surprise bills. 4 - Boost Revenue: Fewer denials mean faster payments and a healthier bottom line. How to Avoid It: - Use Eligibility Portals: Most insurance companies provide online portals where coverage can be checked quickly. - Verify Prior to Every Appointment: Don’t assume coverage remains the same. Verify coverage for every visit. - Contact Insurers Directly: If portals aren’t updated, confirm coverage by calling the insurance provider. - Train Your Team: Make sure your staff knows how to verify coverage effectively and keep a record of all verifications. By making insurance verification a standard step in your process, you can minimize denials and maximize cash flow. #RevenueCycleManagement #InsuranceVerification #HealthcareBilling #SwiftMedicalSolutions #PreventClaimDenials

Navigating insurance denials and rejections is crucial to your healthcare practice. Missteps can affect the success of your revenue cycle and add administrative tasks, distracting from the true mission—exceptional patient care.  Our latest blog explores effective strategies for handling these challenges, ensuring your practice's financial health and allowing you to focus on patient care. Learn how to distinguish between denials and rejections, understand their impact, and apply targeted management strategies to enhance your billing processes. https://lnkd.in/dKKg8vVd #HealthcareBilling #RevenueCycleManagement #InsuranceDenials #MedicalBilling #blog

Are you facing increasing denials? Your not alone. Over 15% of private insurance claims are denied, costing healthcare providers billions annually. In our latest article, we dive into the financial impact of denials and how operational strategies can mitigate these challenges. Are you ready to minimize denials and boost efficiency? Click to learn how Freed Maxick can help! HTTPS//https://lnkd.in/g54yAWq2

🔍 Ensure Smooth Operations with Accurate Benefits Verification! At EZMedBills, we know that verifying patient insurance benefits is a critical step in ensuring timely payments and avoiding claim denials. Our benefits verification services help your practice: ✅ Confirm patient coverage before services are provided ✅ Reduce claim rejections by catching eligibility issues upfront ✅ Improve patient satisfaction with clear cost expectations ✅ Streamline your revenue cycle by minimizing delays in claims processing Let us handle the complexities of insurance verification so you can focus on delivering exceptional patient care. With accurate benefits verification, your practice can operate more smoothly and efficiently. 📩 Connect with us today to learn how our services can support your practice! #MedicalBilling #HealthcareInnovation #BillingSolutions #EZMedBills #FutureOfHealthcare #RevenueCycleManagement #MedicalPractice #PracticeGrowth #HealthcareProfessionals #MedicalBillingExperts #RevenueOptimization #MedicalBillingServices #HealthcareFinance #ClaimsManagement #MedicalCoding #HealthcareReimbursements #BillingCompliance #MedicalPracticeManagement #InsuranceVerification #PatientBilling #BillingAndCoding #PracticeEfficiency #HealthcareConsulting #RevenueCycleOptimization #MedicalBillingSpecialist