Articles Tagged With: claims
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Malpractice Claims Involving AI Tools Are Emerging: EDs Can Mitigate Legal Exposure
Researchers explored the evolving legal landscape by studying how courts have approached allocation of liability for both AI and other complex medical software.
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Analysis Reveals More About Claims Denials Tied to ACA Marketplace Plans
Meanwhile, evidence mounts indicating access to proper insurance coverage leads to better cancer outcomes.
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Closed Claim Malpractice Data Reveal Actual Legal Risks for ED Providers
Researchers analyzed 6,779 closed claims for adults in the ED and urgent care center settings logged between 2001 and 2015. The top five diagnoses in ED claims were: cardiac or cardiorespiratory arrest, acute myocardial infarction, aortic aneurysm, pulmonary embolism, and appendicitis.
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Survey: Prior Authorization Hassles Persisted Mostly Unabated Through 2020
A public health emergency did not seem to remove many bureaucratic roadblocks, to the frustration of U.S. physicians.
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If CPT Code Changes, Patient Access Can Obtain Payment
Patient access can intervene to stop an unauthorized test, assuming it is not emergent or urgent — or find out if the patient wants to go forward anyway. Registrars' expertise makes all the difference on whether the hospital is paid, and how quickly. Possibly, the health plan will agree a new authorization is unnecessary — as long as the clinical records are sent with the claim.
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Revenue Depends on Correct CPT Codes; Beware Sudden Changes
The revenue loss caused by CPT code changes is nothing short of staggering. When it comes to CPT codes that change after service, one of the biggest challenges is in the surgical space. Learn how some patient access departments are proactively addressing this problem.
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Data Are the Key to Avoiding Claims Denials
Claims denials have increased by 11% nationally since the onset of the COVID-19 pandemic, according to an analysis. Almost half of claims denials are caused by front-end revenue cycle issues, including registration/eligibility, authorization, or service not covered. Implementing a process to check eligibility at multiple points throughout the revenue cycle will go a long way in preventing this common denial from occurring.
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Closed Claims Study Shows Pain Management Risks as COVID-19 Contributes
An analysis of closed medical malpractice claims related to pain management identifies common areas of risk and reveals the COVID-19 pandemic has created new possibilities for liability. A top contributing factor in 90% of all closed claims was insufficient consent between the physician and the patient or family.
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Cardiology-Related Misdiagnoses Frequently Alleged in ED Malpractice Claims
In an analysis, 58% of claims against emergency physicians resulted from misdiagnosis. Diagnosis-related allegations were more common in emergency medicine-related claims (58% of claims) than in claims involving internists (42% of claims). The most common final diagnoses were myocardial infarction, pulmonary embolus, and cardiac arrest.
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Annual Physician Liability Survey Reveals Hardening Markets