In 2023, at least 86 public payer-provider disputes were reported, compared with 51 in 2022, a 69% increase, and 44% failed to reach agreement, sending patients or members out of network, according to PayerSet's dispute data. That's
In 2023, at least 86 public payer-provider disputes were reported, compared with 51 in 2022, a 69% increase, and 44% failed to reach agreement, sending patients or members out of network, according to PayerSet's dispute data. That's
Monday morning starts with three procedure rooms, an ambulatory surgery center, and a hospital outpatient department sending charges into the same billing queue. The team has EGDs, colonoscopies, pathology, anesthesia, follow-up visits, and screening procedures that became
20% of in-network claims were denied in 2023, 36% of out-of-network claims were denied, and fewer than 1% of denied claims were appealed. That means insurance claim disputes aren't rare edge cases, they're a structural part of
A denial hits your work queue before coffee. The claim looked routine when it left the office. The procedure was performed, the note was signed, and the code selection seemed defensible. Then the payer asks for records,
A large share of ambulance revenue problems start long before the first denial letter arrives. In a cross-sectional study of over 2 million ground ambulance services, 54.8% were billed out-of-network, and patients faced a mean total financial
