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

Features

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 rely...


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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...

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...

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....

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....

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...

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...

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...

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...

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...

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...

What a Trump Presidency Means for Value-Based Care and the ACA

Love it or loathe it, the United States is headed for four years of drastic policy changes under a Donald Trump administration, giving lawmakers another good chance to repeal, replace, or revise the Affordable Care Act. The landmark healthcare...

How to Maximize Revenue with Improved Claims Denials Management

Claims denials may be a part of life for healthcare revenue cycle managers, but a prevention-focused denials management strategy may be able to significantly reduce the number of times billing staff are faced with unpaid claims. Recent healthcare...

CMS Timelines for Stage 3 Meaningful Use, MACRA Implementation

For Medicare providers, CMS has set the pace for quality improvements and healthcare payment reform through Stage 3 Meaningful Use and the Quality Payment Program (under MACRA implementation). The programs are designed to put providers on track...

Understanding the Value-Based Reimbursement Model Landscape

In January 2015, the Department of Health and Human Services (HHS) announced that it intends to link half of all traditional Medicare payments to a value-based reimbursement model by the end of 2018.  The announcement, followed...

Key Ways to Boost Collection of Patient Financial Responsibility

Ever since the Affordable Care Act was passed in 2010, more providers are experiencing a shift in healthcare revenue sources, especially as patient financial responsibility increases. While hospitals and physician practices traditionally communicated...

Preparing the Healthcare Revenue Cycle for Value-Based Care

Not only do value-based care models aim to make healthcare providers more accountable for the services they provide to patients, but they are also designed to shift financial accountability away from payers to healthcare organizations. However,...

What Is Healthcare Revenue Cycle Management?

While hospitals, small practices, and larger healthcare systems are known for saving lives and treating patients, every healthcare organization needs to develop successful processes and policies for staying financially healthy. That is where...

What Is Value-Based Care, What It Means for Providers?

Value-based care is a form of reimbursement that ties payments for care delivery to the quality of care provided and rewards providers for both efficiency and effectiveness. This form of reimbursement has emerged as an alternative and potential...

Using Revenue Cycle Analytics for Effective Value-Based Care

The hospital industry has been experiencing a number of challenges in recent years due to the payment reforms coming from the Centers for Medicare & Medicaid Services (CMS) and commercial health payers. There has been a much greater push...

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