Claims Denials Archives - Page 2 of 3 - Sift Healthcare
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...
How to Know if a Denial Cluster is Worth Automating with an AI Agent
Agentic AI is being hailed across the revenue cycle right now, for appeals, claim resubmissions, documentation retrieval and a slew of other workflows. For the most part, the use cases make sense on paper. But many health system revenue cycle teams are making deployment decisions based on...
CEO Perspectives: Health Systems Are Wrong About Their Denial Rates
I don’t mean that to be provocative, I mean it literally. The number any given hospital revenue cycle team reports as its denial rate is almost certainly not its denial rate. Upstream Revenue Loss Most health systems measure denials through...
Segment Loop 2110: Another Way Your 835 Isn’t Showing Your Denials
The Loop 2110 segment was designed to communicate payer decisions. But payers have moved on, and health systems still managing denials through the remittance file are working with an incomplete picture. We’ve seen an influx of Google searches for “835...
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...
Most providers aren’t monitoring PLBs. Payers know it.
PLB data is rich in information, telling you which payers are recouping, how often, and in what patterns. But you won't see it in static retrospective RCM reports or standard denial dashboards. If your team isn't actively monitoring PLB activity...
How Real-Time Clinical Data Is Revolutionizing Payer Reimbursement
How real-time clinical data is transforming insurance payer reimbursement, reducing claim denials, and streamlining healthcare revenue cycle management.
Introducing the Solventum Revenue Integrity System
Introducing the Solventum Revenue Integrity System from Sift and Solventum. This AI-driven solution unifies clinical and payments data, predicts and prevents clinical denials and optimizes revenue cycle management.
2022 Healthcare Denials Insights
Denials are a significant and persistent obstacle for health systems and hospitals. They slow down receivables and add unnecessary administrative burdens. Sift Healthcare’s 2022 Denials Insight Report contains granular denials insights and action items to track root causes, prevent denials,...
4 Key Areas To Focus On To Recover Missed Receivables Or Accelerate Cash
Sift's VP of Product & Client Success, Blake Sollenberger, talks denials management, covering 4 key areas health systems and hospitals can focus on to recover missed receivables or accelerate cash.