How to Solve Healthcare’s Accounts Receivable Problem

Overall cost reduction and efficiency are some of the top financial priorities for today’s health system CEOs and CFOs. Faced with problems like shrinking revenue and increasing expenses, executives should start employing technological solutions, such as intelligent automation, to handle claims, increase efficiency and expedite insurance recovery.

Old ship with lots of sails at night with storm

Uncertainty Clouds Two-Midnight Rule; Poses Ongoing Denial Risk

Difficult and sometimes treacherous for ships at sea, navigating in the dark can be equally perilous for hospitals struggling to comply with Medicare’s murky two-midnight inpatient admissions rule. To minimize two-midnight denials and optimize collections, hospitals need to have a concise understanding of how the rule works.

Physicians Seek Reprieve from Prior Authorization Burden

For physicians, being forced to obtain insurance company prior authorization before providing or ordering a specific treatment probably feels a lot like needing a permission slip from your parents in high school. Not only does the process cause frustration and resentment, it can also lead to treatment delays and substandard care. Five areas of improvement have been identified and are now the basis for proposed federal legislation.

Clinical Labs Benefit from Comprehensive, Automated Approach to Denial Resolution

Clinical labs typically generate low-dollar/high-volume claims which many hospitals don’t aggressively pursue. However, hospitals can generate a substantial source of revenue by taking a more aggressive and systematic approach to lab denials.

Attacking the Root Causes of Radiology Denials

Radiologists face unique challenges when it comes to getting paid. Coding for imaging is complex and multi-faceted, and documentation must be thorough and precise. In addition, unlike most other specialists, radiologists are usually dependent on the referring physician’s office or emergency department to document medical necessity or ensure that any required prior authorizations are obtained.

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