Claims reimbursement
Providers rely on payer reimbursement to cover the costs of providing healthcare services. Without timely and complete reimbursement, providers may struggle to maintain operations. Effective claims management helps to reduce errors and minimize fraud risk while streamlining the reimbursement process to decrease denials.
Top Stories
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News
18 Mar 2026
CMS to install centralized IDR platform for disputes
Coming later this year, the IDR Gateway will provide a centralized platform for managing claims under the independent dispute resolution process. Continue Reading
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Feature
17 Mar 2026
How AI scribes are shifting coding intensity, reimbursement
The proliferation of AI scribes for clinical documentation has started a shift in coding intensity, raising concerns about reimbursement and affordability. Continue Reading
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Answer
06 Jun 2019
How Advocate Aurora Health Streamlined Prior Authorizations
The health system reduced the burden of prior authorizations while upping medication adherence by automating the process in the EHR and creating an authorization team. Continue Reading
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News
11 Mar 2019
Why Do We Need Artificial Intelligence in Healthcare?
Artificial intelligence in healthcare can lead to immediate gains by reducing inefficiencies in the revenue cycle. Continue Reading
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News
07 Jan 2019
Maximize Hospital Revenue with a Holistic Insurance Discovery Strategy
Looking beyond self-pay accounts for insurance discovery and identifying valuable coverage information helps both recover—and increase—hospital revenue. Continue Reading
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News
10 Dec 2018
Getting the Medicare Cost Report Right the First Time
Data analytics can help hospitals submit a complete and accurate Medicare cost report in the face of constant rule changes and an uptick in audits. Continue Reading
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News
03 Dec 2018
Healthcare Payment Integrity is Vital to Maximizing Reimbursements
Identifying underpayments or claiming supplemental reimbursement is resource-intensive, but a healthcare payment integrity solution can recoup lost revenue. Continue Reading
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News
17 Sep 2018
How Automating Payer Enrollment Reduces Time to Reimbursement
A lack of automation for payer enrollment and other claims management processes is delaying reimbursement, but outsourcing payer enrollment can reduce the wait. Continue Reading
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Answer
10 Sep 2018
RCCH Uses Predictive Analytics to Boost Claim Denials Management
A Tennessee-based healthcare organization uses predictive analytics to identify high-value denials and add accountability to their claim denials management strategy. Continue Reading
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News
10 Sep 2018
Using Payer Enrollment to Jumpstart Revenue Cycle Optimization
Outsourcing payer enrollment services helps healthcare organizations streamline the enrollment process, navigate payer rules, and monitor revalidation. Continue Reading
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Answer
04 Sep 2018
Artificial Intelligence Ensures Payer, Provider Pay Covers Costs
Gateway Health Plan is using artificial intelligence to improve its risk adjustment programs, which ensure the payer and its providers receive reimbursement that covers a patient’s total cost of care. Continue Reading
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News
16 Jul 2018
Overcoming the Top Challenges of Claims Denial Management Audits
Increasing efficiency and improving revenue are top priorities for health care providers with a big focus on improving prior authorizations and eligibility before an episode of care. Continue Reading
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News
23 Oct 2017
4 Strategies for Merit-Based Incentive Payment System Success
Eligible clinicians can prevent a Merit-Based Incentive Payment System penalty in 2017 by selecting the right measures and engaging their vendors and physicians. Continue Reading
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Feature
06 Oct 2017
Maximizing Revenue Through Clinical Documentation Improvement
A strong revenue cycle rests on accurate, timely data. Clinical documentation improvement offers an opportunity to improve coding and maximize reimbursement. Continue Reading
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News
28 Sep 2017
Cancer Care Costs 60% Higher at Hospitals Vs Independent Orgs
Cancer care costs for chemotherapy and physician visits are significantly less at independent community oncology practices, a study showed. Continue Reading
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Feature
11 Aug 2017
Key Strategies for Succeeding with Healthcare Bundled Payments
In order to succeed with healthcare bundled payments, providers must engage post-acute care providers, leverage data analytics, and improve their patient engagement strategies. Continue Reading
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News
20 Jul 2017
3 Challenges Providers Face with Healthcare Bundled Payments
The top challenges of healthcare bundled payments include achieving scale, leveraging post-acute care resources, and managing uncontrollable costs. Continue Reading
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Feature
09 Jun 2017
The Difference Between Medicare and Medicaid Reimbursement
Medicare and Medicaid reimbursement models vary according to federal and state regulations, but both are striving to embrace value-based reimbursement. Continue Reading
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News
11 May 2017
3 Best Practices for Hospital Claim Denials Management
Implementing claim denials management best practices is key to ensuring hospitals maximize claims reimbursement revenue and prevent denials. Continue Reading
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News
10 Mar 2017
Top 4 Claims Denial Management Challenges Impacting Revenue
Common claims denial management obstacles for providers include quantifying denial rates, using manual processes, receiving preventable denials, and appealing claims. Continue Reading
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Feature
04 Nov 2016
How to Maximize Revenue with Improved Claims Denials Management
Enhancing claim denials management strategies can help providers recoup lost healthcare revenue and maximize reimbursements. Continue Reading
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News
02 Aug 2016
4 Medical Billing Issues Affecting Healthcare Revenue Cycle
Addressing these four common medical billing challenges can have a positive impact on the healthcare revenue cycle. Continue Reading
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News
15 Apr 2016
Defining the Top 10 Terms of Healthcare Revenue Cycle Management
MACRA, MIPS, accountable care, and supply chain management are among the top terms used by healthcare revenue cycle pros. Continue Reading
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Feature
12 Apr 2016
Key Ways to Improve Claims Management and Reimbursement in the Healthcare Revenue Cycle
To keep pace with changes to healthcare reimbursement, hospitals and healthcare organization need to reduce inefficiency in revenue cycle management. Continue Reading
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News
21 Sep 2015
3 Strategies to Improve Healthcare Supply Chain Management
The evolution and progression of supply chain and reimbursement tactics and procedures within the healthcare industry serves as a keen present focal point. Continue Reading
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News
30 Mar 2015
Quantify Denial Rates for Smooth Revenue Cycle Management
The ability to swiftly and economically scrub claims and quantify denial rates is critical to ensure smooth revenue cycle management. Continue Reading
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News
09 Mar 2015
What Steps Comprise the Life Cycle of a Medical Claim?
It is important to recognize and distinguish each stage from the other within the total life cycle of a medical claim to decrease errors and cost. Continue Reading
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News
04 Nov 2014
Examining Differences Between Medicare, Medicaid Reimbursement
While Medicare and Medicaid are similar programs, there are different challenges when it comes to reimbursement. Continue Reading