Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Features

Data Analytics Add Value to Healthcare Supply Chain Management

Hospitals spend nearly one-third of their overall operating expenses on healthcare supply chain management. Buying supplies, equipment, and the latest innovations to support high-value care delivery is expensive, especially as hospitals and health systems expand their provider networks. Data analytics tools have the potential to give supply chain leaders insights into how to reduce their...


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How Hospital Merger and Acquisition Activity is Changing Healthcare

As value-based reimbursement puts financial pressure on providers, healthcare organizations are striving for efficiency, cost control, and sustainability. An increasingly popular strategy to fulfill all these goals is to engage in hospital merger and acquisition (M&A) activity. Hospital mergers and acquisitions are increasing at a rapid rate. Healthcare organizations announced 115 me...

Exploring the Fundamentals of Medical Billing and Coding

Medical billing and coding translate a patient encounter into the languages used for claims submission and reimbursement. Billing and coding are separate processes, but both are crucial to receiving payment for healthcare services. Medical coding involves extracting billable information from the medical record and clinical documentation, while medical billing uses those codes to create i...

Maximizing Provider Revenue with Payer Contract Management

Ensuring correct reimbursement in a timely manner is always at the top of a healthcare provider’s mind. But many provider organizations could be leaving money on the table with inefficient and infrequent payer contract management. Payer contracts contain fee schedules and reimbursement requirements, as well as the conditions payers must meet for timely reimbursement. Therefore, pay...

Hospital Utilization Management Can Reduce Denials, Improve Care

Utilization management in healthcare is commonly thought of as a strategy that payers employ to control resource use within physician offices and hospitals to keep healthcare costs down. However, hospital utilization management programs are also an essential part of a provider organization’s revenue cycle, helping to prevent unnecessary costs and claim denials. According to the Hea...

The Role of the Hospital Chargemaster in Revenue Cycle Management

The hospital charge description master, or hospital chargemaster, is at the heart of the healthcare revenue cycle, serving as the hospital’s starting point for billing patients and payers. A hospital chargemaster is a list of all the billable services and items to a patient or a patient’s health insurance provider. The chargemaster captures the costs of each procedure, servic...

Pay-for-Performance Strategies for Independent Physicians, Small Practices

Pay-for-performance models aim to reward providers for high-quality care at lower costs. However, value-based reimbursement structures tend to require substantial upfront and ongoing investments and put practice revenue at risk, straining the already tight profit margins of independent physicians and small practices. Current models typically require extensive practice transformations tha...

For Ongoing ACO Shared Savings, Look Outside Inpatient, Primary Care

Seven years have passed since the Affordable Care Act catalyzed the idea of volume over value in the healthcare industry, paving the way for accountable care organizations (ACOs) to accrue shared shavings while focusing on population health. Since that time, the number of ACOs has exploded to over 920 organizations contracted with public and private payers.  More than 10 percent of ...

Overcoming Rural Hospital Revenue Cycle Management Challenges

Despite serving as a critical healthcare safety net for millions of patients, many rural hospitals are constantly on the brink of closing their doors due to a number of revenue cycle management challenges.  Eighty-two rural hospitals have closed since 2010, and many more are considering shutting down because of low operating margins, challenging patient populations, and provider sho...

Maximizing Revenue Through Clinical Documentation Improvement

Clinical documentation improvement (CDI) is the process of enhancing medical data collection to maximize claims reimbursement revenue and improve care quality. In addition to its impact on patient care, the quality of data generated within the electronic health record and elsewhere in the organization is increasingly tied to cost efficiency under value-based reimbursement models. Payers ...

Good Data, Better Value-Based Care Can Boost Population Health

With just 5 percent of patients accounting for nearly one-half of the nation’s healthcare spending, hospitals and health systems have a significant opportunity to address a large proportion of their costs by improving the health of a relatively small number of individuals. In order to do so, healthcare organizations need to develop population health management interventions tailore...

Key Strategies for Succeeding with Healthcare Bundled Payments

Healthcare bundled payments are a value-based reimbursement model that uses a single, comprehensive payment to address an entire defined episode of care. This alternative payment model has become a critical stepping stone for providers as they explore risk-based purchasing. Unlike other common alternative payment models, such as accountable care organizations (ACOs) and capitation, bundl...

How Providers Can Detect, Prevent Healthcare Fraud and Abuse

Healthcare fraud and abuse cases cost the industry billions of dollars a year. Without processes in place to detect and prevent fraudulent activities, healthcare providers could face an investigation that may cost them their reputation and revenue. However, developing appropriate healthcare fraud and abuse prevention policies and compliance programs may be difficult for provider organiza...

The Difference Between Medicare and Medicaid Reimbursement

Medicare and Medicaid are government healthcare programs that help individuals acquire coverage, but similarities between the programs more or less end there. Medicare and Medicaid reimbursement structures vary significantly by program and state. HHS describes Medicare as an insurance program, whereas Medicaid is an assistance program. The federal government offers Medicare coverage to i...

After EHR Adoption, Revenue Cycle Technology Modernization Begins

Electronic health records (EHRs) revolutionized the way healthcare organizations collect, analyze, and report patient and practice data. And now that nearly 97 percent of hospitals and almost three-quarters of providers are using certified EHR technology, many organizations are angling to adopt revenue cycle management solutions to complete their conversions to a digital environment.&nbs...

Leveraging Group Purchasing for Hospital Supply Chain Management

Good things may come in small packages, but hospitals and health systems on the smaller end of the spectrum oftentimes face higher hospital supply chain costs because of their size. Larger hospitals and health systems tend to have more power behind them to negotiate lower supply chain prices. Since larger organizations order more items in bulk, manufacturers and other vendors offer these...

Best Practices for Value-Based Purchasing Implementation

The value-based purchasing boat is leaving the dock and providers can either choose to board and shift their care delivery and reimbursement methods to align with the push for value or be left behind. Value-based purchasing made a splash as part of the Affordable Care Act, but the federal government recently set more aggressive goals for shifting healthcare payments away from fee-for-ser...

Understanding the Quality Payment Program’s Advanced APM Track

From bundled payments to accountable care organizations, alternative payment models (APMs) are not new to healthcare providers. But the final MACRA implementation rule created a new subset of Advanced APMs, which could bring providers more revenue under the Quality Payment Program. Eligible clinicians in the Quality Payment Program have two participation options: the Merit-Based Incentiv...

Exploring Two-Sided Financial Risk in Alternative Payment Models

As value-based care becomes the name of the game in healthcare, public and private payers are pushing providers to take on more financial accountability for their services through alternative payment models. In a fee-for-service world, providers received reimbursement for every test or procedure they performed without being penalized or rewarded if their services impacted patient outcome...

Top Revenue Cycle Management Vendors and How to Select One

As value-based reimbursement models, such as the upcoming Quality Payment Program, break down the walls between care quality and healthcare payments, more providers have set their sights on implementing vendor-sponsored revenue cycle management solutions that can manage the integration of reimbursement and value. The healthcare revenue cycle management software and services industry is p...

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