by Aspirion | May 20, 2022 | Denials Management
It is relatively easy to identify the root cause of an inpatient denial due to a procedural matter like failure to obtain an authorization. But what is the root cause of an inpatient denial when the hospital does everything ‘right’? They notify the correct insurance...
by Aspirion | Oct 11, 2021 | Denials Management
The Employee Retirement Income Security Act of 1974 (ERISA) is a federal law that, in part, enables beneficiaries to appeal any covered insurance claim to request payment in full. Sounds simple, but it’s not. ERISA is a complex set of laws, and one article definitely...
by Aspirion | Aug 31, 2021 | Denials Management
Many times, payers deny specific patient treatments, drugs, or hospital stays due to the specific treatment or drug being considered non-covered or experimental. While these claim denials can be argued in a formal appeal on the back end, a health system can also...
by Aspirion | Jul 7, 2021 | AR Management, Denials Management, Motor Vehicle Accident, Out-of-State Medicaid, Payment Variance Recovery, Staff Training, Veterans Affairs - TRICARE, Workers’ Compensation
Beginning July 1, 2021, United Healthcare (“UHC”) will begin reviewing Medicare Advantage and commercial claims for sepsis-related treatment on a pre-payment basis and post-payment basis. Previously, UHC only reviewed sepsis-related claims on a post-payment basis....
by Aspirion | Jul 8, 2020 | AR Management, Denials Management, Payment Variance Recovery
Approximately 5-10% of medical billing claims are rejected each year. These claims are extremely expensive to rework, requiring resubmissions and hindering productivity. To maximize revenue integrity, facilities must start by identifying how their denials are holding...
by Aspirion | Mar 18, 2020 | Denials Management
Disability is a lengthy and arduous process; waiting on a case to be determined by the Social Security Administration (SSA) for disability can be a daunting experience. Claimants are commonly faced with medical issues, mounting medical bills, and little to no income....
