Showing posts from November, 2023

3 key interventions to address lagging payer reimbursements

  It seems as if  commercial payers are doing all they can to keep from reimbursing providers in a timely manner. According to a recent  report by Crowe , 31% of claims submitted to commercial payers in the first quarter of 2023 were not paid for at least three months, as compared with 12% of Medicare claims. Medical necessity denials have risen as well. During the same timeframe, inpatient claims denied due to medical necessity issues were 3.2% among commercial payers and 0.2% for Medicare. Commercial payers have 12 times the denial rate that Medicare has based on requests for more information, according to Crowe. The following are three key interventions providers can implement now to help them do just that. Key intervention 1 Negotiation and contract m anagement optimization Hospitals can work with hundreds of payers, each with its own contract terms, processes,and ever-changing requirements. Managing these contracts can be challenging for resource-strapped organizations. However, i

Worth the read: Recent HHS-OIG advisory opinion

  © yavdat - Simply  stated , “[p]ursuant to section 205 of the Health Insurance Portability and Accountability Act of 1996 ( HIPAA ), Public Law 104–101, codified at section 1128D of the Social Security Act (Act), the Secretary must publish advisory opinions regarding the application of the Federal anti-kickback statute and the safe harbor provisions, as well as certain other administrative sanction authorities, to parties’ proposed or existing arrangements.” For those unfamiliar with U.S. Department of Human of Health and Human Services Office of the Inspector General’s (HHS OIG) advisory opinions, an advisory opinion may be requested with regards to the following: What constitutes prohibited remuneration under the Federal anti-kickback statute; Whether an arrangement or proposed arrangement satisfies the criteria in section 1128B(b)(3) of the Act, or established by regulation ( i.e. , safe harbors), for activities which do not result in prohibited remuneration; What