Code Encounters

Managing out-of-network denials refers to the process of addressing and resolving claims that are rejected by insurance providers due to the healthcare service being rendered by a provider who is not part of the insurance network. This can result in the patient being responsible for paying a larger portion of the bill or the entire cost of the service. Effective management of out-of-network denials involves understanding the reason for the denial, appealing the decision, and exploring alternative payment options to minimize the financial impact on the patient.

It was a cold winter’s night, and the urgent care was slow.   

Don’t wait too long to realize you need help with your Revenue Cycle. Too many providers ignore the warning signs of a poorly performing revenue cycle and are barely keeping their heads above water. Physicians and providers have a challenge as they rely heavily on others, typically to ensure that they are utilizing best practices and measuring key performance indicators to indicate healthy revenue cycle practices. Many don’t realize their reimbursements aren’t measuring up until it is too late. A good practice is to have an independent review/audit by an outside consultant at least annually and sometimes more frequently if you are experiencing poor financial performance. Consultants can not only identify gaps and lags in your revenue cycle but provide education to your current staff if needed. They can identify any revenue risk areas or areas of revenue loss.

Are you managing your denials appropriately and efficiently? Do you have a denial strategy? Have you identified a spike in denials? Here is what you need to know.

Healthcare organizations that achieve Joint Commission accreditation meet or surpass CMS’s standards for acceptance into the Medicare and Medicaid programs. To keep accreditation in good standing being permanently prepared for “surprise inspections” is integral as requirements change.

As many RHC providers can attest, it feels like they are the ugly stepchildren of CMS at times. Many Medicare benefits were not payable in the past to an RHC provider. CMS has implemented some needed changes effective January 1, 2022