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As the use of artificial intelligence (AI) in healthcare claims management widens, the importance of careful oversight is needed. Any use of automation for claim denials should be scrutinized by providers to ensure the denial is appropriate. A recent Healthleaders report asked a key question all revenue cycle managers must consider: What is the balance […]
White Papers
The financial impact of the IPO list magnified with the rise of CMS-4201-F, giving rise to inpatient reimbursement for all MAO patients who require services designated on the IPO list. Hospitals need to ensure that the proper setting is scheduled when any Medicare or MA patient undergoes a procedure designated on the IPO list, and they should also follow any proposed additions and removals to the list closely to ensure appropriate treatment and reimbursement.
Case Studies
THE CHALLENGE In 2025, inpatient (IP) and outpatient healthcare claim denials increased by 12% and 14% respectively and the average amount per claim increased by 18%1, forcing hospitals to address payer denials head-on. Most health systems deploy a multi-prong approach to ensure appropriate reimbursement, including outsourcing at least a portion of their revenue cycle operations. […]