RACMonitor: OIG Report on Medicare Advantage Organization Denials
Dr. Ronald HirschMay 11, 2022
The OIG’s determinations seem to fly in the face of the basic concepts of medical necessity.
Start Preparing Now for the CMS Appropriate Use Criteria (AUC) Program
Maddie CorriganSeptember 28, 2021
The imaging market in the United States is estimated to generate more than $100 billion annually. While approximately 60% of the imaging volume is conducted within hospitals, making imaging a key source of ...
Becker's Hospital Review: Financial Resilience and Providing Quality Care in a COVID-19 World
Dr. Maurice AllgeierSeptember 22, 2021
Dr. Maurice Allgeier, Vice President of One Pediatrics, recently recorded a podcast with Becker's Hospital Review where he discusses how an independent practice can maintain financial resiliency during COVID-19 and why integrated care models are more important than ever. Dr. Allgeier specifically covers how One Pediatrics got more ...
For The Record: Avoid Prior Authorization Denials with Front-End RCM
Connie SmithSeptember 8, 2021
The cost and administrative burden associated with prior authorizations is not new, nor is it getting better for physicians or health systems. According to MGMA, provider practices report a
Journal of AHIMA: Appeals, Denials, HIM and Utilization Review - A Winning Combination
Dr. Ronald HirschAugust 23, 2021
Many claim that people in the United States have access to the best healthcare in the world. And while that is easily refuted with data from multiple sources, there is no question that the United States has one of the most complex healthcare delivery systems in the world. The combination of public ...
RAC Monitor: Rebilling Non-Medicare Inpatient Claims
Dr. Ronald HirschMarch 26, 2021
It is crucial to understand the differentiation between a denial for lack of medical necessity and a denial for incorrect status.
Getting the Greatest ROI from Revenue Cycle Automation
Philip MilsomMarch 10, 2021
A year after operating margins dipped into negative numbers and YOY revenues decreased as much as
