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Defend Against Sepsis Denials: A Root Cause Analysis for DRG Downgrades
The Sepsis Denial Crisis in Hospital Revenue Cycles Sepsis-related DRG downgrades are among the most financially damaging and preventable...
Adi Tantravahi
19 minutes ago7 min read
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How to Stop Losing Money on ESRD Claims: A Complete Guide to CPT® 90960, ICD-10 N18.6, and CARC 16 Denials
The Problem Every month, physicians deliver complex, ongoing care to ESRD patients. But even when that care is delivered correctly, it...
Juan Lozano
Jun 114 min read
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A VP of Revenue Cycle's Strategic Guide to DRG Downgrades
Preparing for the New Era of AI-Powered Audits The Landscape is Changing – Are You Ready? DRG downgrades are on the rise. Medicare...
Adi Tantravahi
Jun 48 min read
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Inpatient vs. Observation: How AI Enhances Utilization Review Processes
Nearly 15% of all healthcare claims submitted to payers for reimbursement are initially denied, with more than half eventually overturned...
Oran Lopez Reed
May 206 min read
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What Are Medical Necessity Denials? A Comprehensive Guide for Hospital RCM Administrators
Nearly three in four healthcare providers report that insurance claim denials have increased between 2022 and 2024, with approximately...
Oran Lopez Reed
May 2012 min read
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Healthcare Demo Day: Founder Insights and Reflections
Connecting Innovation with Opportunity At Cofactor, we're passionate about building bridges between innovative healthcare startups and...
Luke Chan
May 123 min read
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How Case Mix Index Affects Contract Negotiations: A Comprehensive Guide for Hospital Administrators
Healthcare providers are experiencing increasing financial pressure, with PwC projecting an 8% year-on-year medical cost trend in 2025...
Oran Lopez Reed
May 810 min read
18
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The Effects of RAC Audits on Hospitals: Strategies for Success in 2025
According to recent data, Recovery Audit Contractors (RACs) recovered over $2 billion in improper payments in FY 2021 alone, creating a...
Oran Lopez Reed
May 89 min read
73
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Decoding CARC 129: Mastering the Critical Relationship Between CPT® 90460 and ICD-10 Z23
When "Prior Processing Information Appears Incorrect" Costs You Money Let's face it - pediatric immunization billing is tricky. At the...
Juan Lozano
May 73 min read
14
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Showcasing Innovation: A Spotlight on Healthcare Demo Day Startups
Chicago has emerged as a vibrant nerve center for healthcare technology innovation, with a thriving ecosystem of startups tackling some...
Luke Chan
May 210 min read
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How to Appeal Inpatient Denials at Scale: A Comprehensive Guide for Hospital Administrators
According to Experian Health's 2024 State of Claims report , a staggering 73% of healthcare providers report that claim denials are...
Adi Tantravahi
Apr 256 min read
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Using AI to Identify and Combat DRG Downgrades: A Strategic Approach for Hospital Revenue Protection
Introduction Recent data from the American Hospital Association reveals that between 2022 and 2023, Medicare Advantage claim denials...
Adi Tantravahi
Apr 257 min read
55
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What You Should Do to Submit Inpatient Appeals Effectively: The Complete Guide
Nearly 15% of all medical claims submitted to private payers and approximately 16% of Medicare Advantage claims were initially denied in...
Adi Tantravahi
Apr 258 min read
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Meet Our Healthcare Demo Day Judges
We're thrilled to welcome an exceptional group of healthcare leaders to judge our upcoming Healthcare Demo Day. With diverse backgrounds spanning clinical care, innovation, finance, and technology, these industry experts bring invaluable perspectives to evaluate promising healthcare startups.
Adi Tantravahi
Apr 115 min read
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Navigating the Complex Intersection of CPT® 97110, ICD-10 M16.12, and CARC 273
1. Introduction When therapeutic exercise meets osteoarthritis in the medical billing landscape, precision becomes paramount. The...
Juan Lozano
Mar 254 min read
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The Rural Hospital Crisis: Recovering Critical Revenue to Preserve Healthcare Access
Alarming new data fromCHQPR reveals 748 rural hospitals across America face potential closure due to financial distress
Adi Tantravahi
Mar 134 min read
28
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Cofactor Joins NVIDIA Inception: Accelerating Innovation in AI-Driven Clinical Decision Support
Cofactor joins NVIDIA's Inception Program, gaining AI resources and mentorship to revolutionize healthcare revenue cycle management tools.
Adi Tantravahi
Feb 192 min read
63
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Exploring How Age Influences Medical Charges: Insights on S5170 + R69 and 71045 + J90
Patient age significantly impacts medical billing, with older adults often incurring higher charges due to complex care needs and insurance
Juan Lozano
Feb 43 min read
47
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Mastering the Interplay of CPT® 3079F, ICD-10 I10, and CARC B7 in Medical Billing
Understanding blood pressure monitoring codes: Learn when and how to use CPT 3079F for diastolic readings of 80-89
Juan Lozano
Feb 14 min read
44
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When Algorithms Decide Who Lives and Who Suffers
The choices we make now will determine not just the future of healthcare, but the kind of society we leave to our children. Will we...
Adi Tantravahi
Jan 144 min read
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