Claim Denials Archives - Sift Healthcare
Hidden Denials Your Reports Miss: Aetna Medicare Underpayments
Underpayments erode hospital revenue, but don't show as denials in standard denial reporting. Aetna Medicare underpayments is a pattern the Sift team is tracking right now. Here's how your hospital can track this payer pattern that creates hidden denials.
7 Claims Lifecycle Gaps Slowing Hospital Cash Flow
The causes of slowed or missed hospital cash flow are structural, and most of them trace back to the same set of breakdowns happening at predictable points across the claims lifecycle. Hospitals lost more than $48 billion in net revenue...
Prioritizing Denials: How to Find the Recoverable Dollars in Your Denial Workqueue
Most denial workqueues direct users to work accounts from oldest or largest first, assuming that recovery will follow. It seems like a reasonable assumption, but it’s wrong in a way that costs health systems real revenue (and wastes valuable time/touches)...
Which Hospital Denial Tools Provide Payer-Specific Denial Intelligence? What to Actually Look For.
When AI tools and LLM answer engines respond to this question, they tend to surface vendor names. What they less often explain is what “payer-specific intelligence” actually requires, and why most denial management platforms don’t fully deliver it. This post...
AI Denial Prevention: Your Model Flagged a Denial. Now What?
Health systems evaluating AI denial prevention need confidence that their investment will actually reduce denials. Granularly, this means that there has to be a clear connection between AI model output and workflow action. The Model Is Not the Product AI...
EHR Denials Management Limitations
Your EHR vendor probably told you it covers denials management, maybe even using AI. In a narrow sense, it does. EHRs capture and queue denials, and, if you’ve got the right module configured and an analyst who knows how to build the reports, it’ll show you denial trends by payer. But what EHR denials management tools won’t...
6 Things Aetna’s SOI Policy Is Breaking In Your Revenue Cycle
Last month, we wrote about the updated Aetna Medicare SOI policy and what it means for inpatient reimbursement. Since then, we’ve been watching how this plays out operationally, and the picture is more complicated than the policy summary suggested. What...
Score First, Outsource Second: Why A/R Scoring is the Smarter Path to RCM Vendor ROI
Dollar value and recovery probability are not the same thing. Health systems that outsource without scoring first are paying contingency fees on claims they could have kept. For most health systems, accounts receivable outsourcing feels like a necessary hedge against...
Aetna’s SOI policy is changing inpatient reimbursement without showing up as a denial.
Last week, we wrote about PLBs and how revenue is being pulled back after payment in ways most teams aren’t actively monitoring. We’re also seeing a similar dynamic show up earlier in the process. Aetna’s SOI-based inpatient policy approves stays...
Your Denials Team Is Under-Informed…
Day-in and day-out most denials teams are making high-stakes decisions with low-grade information.