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Should You Automate to Resolve Health Claim Denials?
Absent commercial health insurance companies fulfilling a recent promise to reform their prior authorization (PA) and claims-paying behaviors, what can hospitals and health systems do to combat increasing claim denials and their growing threat to clinical and financial sustainability?
The Case for Automating to Resolve Health Insurance Claims Denials
Automating health care insurance claims management with AI-powered tech can speed denials resolution - TrailBlazers
New Solution Helps to Address Unfair Commercial Health Care Plans
To help members reduce the significant operational challenges caused by some of these commercial payer issues, the AHA has also launched a new solution, the AHA Vitality Index.
Hospital Trendwatch Chart 1.14: Number and Percent Uninsured, 1990-2019, 2021, and 2022
See hospital trends in AHA Trendwatch Chartbook Chart 1.14: Number and Percent Uninsured, 1990-2019, 2021, and 2022.
Skyrocketing Hospital Administrative Costs, Burdensome Commercial Insurer Policies Impacting Patient Care
Between 2022 and 2023, care denials increased an average of 20.2% and 55.7% for commercial and Medicare Advantage (MA) claims, respectively.
Payer Denial Tactics — How to Confront a $20 Billion Problem
The high cost to health care providers to obtain reimbursement from insurers shows no signs of abating. A recent report from the group purchasing and consulting organization Premier highlights the long-standing problem.
CY2024 Medicare Advantage Final Rule Implementation Handbook
On April 5, the Centers for Medicare & Medicaid Services (CMS) finalized its Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Program for contract year (CY) 2024. The final rule increases oversight of Medicare Advantage (MA) plans and seeks to better align MA coverage with Traditional Medicare.
CMS FAQs on 2024 Medicare Advantage Rule
In this memo, the CMS provides clarification about how MA plans should comply with the 2024 Medicare Advantage rule.
Women’s Health Startup Tia Makes an Impact Treating ‘Medical Orphans’
San Francisco-based Tia launched in 2017 with a vision of reimagining health care with women at the center and helping them to make better decisions about their health. Now, in its first “Women’s Primary Care ‘Plus’ Outcomes Report,” the company shares data about the impact the company is having on its members.
New Consumer Poll Finds Patients Are Concerned about Commercial Insurer Barriers to Care: Infographic
Commercial health insurer policies and administrative practices delay patient care, overburden clinicians and add unnecessary costs to the health care system, according to a new poll of health care consumers conducted by the Morning Consult.