Introduction Recent data from the American Hospital Association reveals that between 2022 and 2023, Medicare Advantage claim denials increased by a staggering 55.7%, representing billions in contested revenue for U.S. hospitals (AHA, September 2024) . With hospital operating margins hovering at just 2.5%, DRG downgrades represent a significant threat to financial sustainability. This guide provides hospital administrators with a practical, step-by-step approach to identify, p

Hospitals lose $19.7B annually fighting denials, yet 54% get overturned on appeal. This guide shows how AI automation reduces appeal time from 4 hours to 15 minutes while increasing success rates. Start reclaiming your revenue today. Nearly 15% of all medical claims submitted to private payers and approximately 16% of Medicare Advantage claims were initially denied in 2024, with inpatient care facing an even higher denial rate of 14.07% ( Premier Inc., February 2024 ). This c

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.

1. Introduction When therapeutic exercise meets osteoarthritis in the medical billing landscape, precision becomes paramount. The relationship between CPT® 97110 (therapeutic exercises), ICD-10 M16.12 (unilateral primary osteoarthritis of the left hip), and CARC 273 (exceeded coverage guidelines) represents one of healthcare's most nuanced coding challenges. This intricate dance of procedural justification, diagnostic specificity, and policy adherence demands sophisticated un

Alarming new data fromCHQPR reveals 748 rural hospitals across America face potential closure due to financial distress

Cofactor joins NVIDIA's Inception Program, gaining AI resources and mentorship to revolutionize healthcare revenue cycle management tools.

Patient age significantly impacts medical billing, with older adults often incurring higher charges due to complex care needs and insurance

Understanding blood pressure monitoring codes: Learn when and how to use CPT 3079F for diastolic readings of 80-89

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 continue to allow faceless algorithms to decide who lives and who suffers? Or will we finally reclaim healthcare's moral center and build a system worthy of our highest values? The murder of UnitedHealthcare Chief Executive Brian Thompson was shocking, but the schadenfreude and the ‘why’ of it all was unsurprising to those of us on the front lin

1. Introduction Understanding the intricate interplay between CPT® code 00142 (”Anesthesia For Procedures On Eye; Lens Surgery”), ICD-10 code H25.11 (”Age-Related Nuclear Cataract, Right Eye”), and CARC B7 ("This provider was not certified/eligible to be paid for this procedure/service on this date of service") is crucial for seasoned billing professionals. These codes are fundamental in the reimbursement workflow for cataract surgeries, and any misalignment can lead to denia

When healthcare giant Steward Health Care filed for bankruptcy  earlier in May 2024, it sent shockwaves through the industry, challenging long-held assumptions about the stability of large hospital systems. The collapse resulted in five hospital closures and approximately 2,400 job losses across Massachusetts, Florida, and Ohio, with most remaining hospitals transitioning to new owners. Amidst this upheaval, a surprising trend has emerged: mid-sized hospitals are hitting a "G

ProPublica reveals how EviCore uses AI to deny healthcare claims, transforming patient restrictions into profits.

Texas' aggressive Medicaid review has left over 2 million residents without healthcare coverage, creating a crisis that affects the state's