The Changing Face of Denial Management

Denial management is one of the aspects that affect physicians, health care providers, insurance providers, and patients alike. The major problems faced by billers and coders along with patients are that the insurance companies or payers deny claims based on any reason they can find. This includes technicalities and some aspects such as pre-existing conditions […]

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Fraud and Abuse: A major reason for waste in the US Healthcare Spending

Health care fraud and abuse is an important and conspicuous factor in the resource and finance drain in the US healthcare system and is responsible, to an extent, for the escalating healthcare costs. According to a report by Thomson Reuters on US healthcare spending, the US healthcare system wastes between $505 billion and $850 billion […]

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Increased inaccuracy in claims payments by health insurers

Commercial health insurance has registered an increase of 2% over the existing average claims processing error rate of 19.3%. This 2% translates to an extra 3.6 million in erroneous claim payments, and costs an additional estimated $1.5 billion in highly avoidable administrative costs to the health system. AMA (American Medical Association) has released its Fourth […]

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