Navigating the complexities of health insurance contracts with providers is a critical endeavor for private practices aiming to maintain financial health and continue delivering quality patient care.

In the complex world of insurance and healthcare claims, the concept of “zero-paid claims” can feel like a phantom menace. You've submitted a claim, received an Explanation of Benefits (EOB) or remittance advice, and to your dismay, the payment is… zero.

From large acute systems to ambulatory practices, healthcare organizations are plagued by an often-overlooked but significant revenue challenge: underpayments.

Six key strategies can enable healthcare organizations to manage an approach with in-house and global support teams to turn denials into an opportunity for improved operational efficiency and profitability

In April 2020, the Federal Medical Assistance Percentage (FMAP) was increased so that states would receive extra funding for their Medicaid programs in support of the COVID-19 public health emergency. In exchange, the states promised to pause Medicaid eligibility checks so that more people would be able to continue to receive Medicaid benefits to get through the pandemic.

The healthcare revenue cycle begins long before a claim is submitted-it starts at the front desk. This critical phase covers all processes from patient registration and insurance verification to prior authorization and point-of-service collections.

Medicare fees have become more complex over the years as new systems are implemented to improve quality while reducing costs.

A conversion factor is a dollar amount that is applied to an adjusted Relative Value Unit (RVU) to arrive at a fee. Conversion factors can be based on a geographic location as well as a national level. The Veterans Administration has provided the following information about how they create their geographically-adjusted 80th percentile conversion factors:

I remember the call distinctly. I had just written an article for a publication titled “How to Negotiate Reimbursement Rates.” Dr. Jordan, a New York dermatologist, called and asked to speak with the author. I replied it was me, and he said, “I really need your help.

Medicare fees have become more complex over the years as new systems are implemented to improve quality while reducing costs.