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.

Clinical Documentation Improvement teams have mastered denial prevention through real-time collaboration and concurrent review. Discover how to transform your denial management program using CDI best practices: pre-submission audits, physician query protocols, cross-functional teams, and predictive analytics. Get actionable strategies to prevent documentation-driven denials, improve appeal overturn rates, and reduce administrative costs.

Newly promoted VP of Patient Financial Services? This complete guide shows how to lead revenue cycle transformation in Epic-based health systems. Learn to standardize multi-site workflows, optimize Epic modules, build high-performance teams, and improve patient financial experience. Includes 90-day action plan, essential KPIs, cross-functional collaboration strategies, and proven examples from leading health systems.

Stop losing revenue to CARC 16 denials on ESRD claims. This complete guide shows nephrology practices how to properly document CPT 90960 monthly services, align ICD-10 N18.6 diagnosis codes, and prevent missing information denials before submission. Includes appeal letter templates, documentation checklists, and proven strategies to improve claim approval rates and recover denied reimbursements for dialysis patient care.

Payer AI systems are processing audits 24/7, targeting high-value DRGs like sepsis and respiratory failure. Learn how revenue cycle leaders are fighting back with AI-powered appeal workflows that reduce processing time by 80-90%, increase appeal volume 3-4x, and turn audits into competitive advantages. Discover implementation strategies, key metrics, and ROI frameworks to modernize your denial management program.

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

Hospital closures accelerate as facilities struggle to find optimal size. While 432 rural hospitals face closure risk and large systems like Steward collapse under bureaucracy, mid-sized hospitals discover the sweet spot: 100-350 beds with strategic technology investment. Explore how balanced operations, AI-powered revenue cycle management, and community focus create sustainable healthcare delivery models that outperform both extremes.