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Aetna's Policy Shift: How "Approved" Inpatient Claims Could Cost You Millions
Aetna's new Medicare Advantage policy will approve inpatient admissions but pay many at observation rates with no appeal rights. Revenue cycle leaders need immediate strategies.
Adi Tantravahi
Aug 133 min read
Establishing a Robust Payer Policy Database: A Strategic Guide for Hospital Administrators
Healthcare claim denials reached an alarming 15% of all claims submitted to private payers in 2024, with providers spending an estimated...
Adi Tantravahi
Jul 236 min read
Denial Workflows: What Denials Management Teams Can Learn from CDI Teams
Healthcare organizations are facing an unprecedented surge in claim denials, with 77% of providers reporting increased denial rates from...
Adi Tantravahi
Jul 236 min read
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 forms of revenue leakage hospitals face. When payers retrospectively challenge sepsis diagnoses and downgrade them to simple infections or pneumonia, the financial hit is immediate: $3,000 to $7,000 lost per case, and over $15,000 for more complex claims. But the impact goes deeper. These downgrades reduce your Case Mix Index (CMI), lowerin
Adi Tantravahi
Jun 207 min read
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