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

Features

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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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 legislation was the centerpiece of one of the most contentious campaigns in American history.  Staring down anticipated premium hikes of up t...

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 reforms, such as reporting-heavy value-based reimbursement models, an updated ICD-10 coding system, and lower payment rates, have made it even ...

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 to achieve healthcare reform and innovation by applying payment incentives or penalties associated with program participation. Providers should b...

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 quickly by the unveiling of the MACRA framework that focuses on alternative payment models (APMs) for quality care improvements, led many providers...

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 with a small group of payers to collect the majority of payments, providers are now seeing patients becoming more accountable for their hea...

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, many providers are left wondering how to align their healthcare revenue cycle management strategies with value-based reimbursement arrangements. ...

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 healthcare revenue cycle management comes in. Healthcare revenue cycle management is the financial process that facilities use to manage the adminis...

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 replacement for fee-for-service reimbursement which pays providers retrospectively for services delivered based on bill charges or annual fee sch...

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 toward value-based care reimbursement and away from fee-for-service payment programs. This has led to the development of bundled payment contracts, ...

What We Know About Value-Based Care Under MACRA, MIPS, APMs

The Medicare Access and CHIP Reauthorization Act of 2015 has many parts tied to Medicare and other federal health plan beneficiaries, but first and foremost it is a bill that brings an end to the sustainable growth rate and a beginning to new incentive programs for providers working in a value-based care ecosystem.* *NB. HHS recently announced the publishing of the proposed rule for MACR...

Key Ways to Improve Claims Management and Reimbursement in the Healthcare Revenue Cycle

Reimbursement is changing in healthcare. Even before elements of the Affordable Care Act began to go into effect, a growing focus on value- based care versus volume has led many healthcare organizations and providers to consider accountable and patient-centered care models in which they assume a greater share of risk. In this changing climate, revenue must be managed differently to ...

Why Healthcare Needs Value-Based Supply Chain Management

Healthcare supply chain — the holistic flow of relationships between suppliers and customers — is about efficiently delivering low cost care as goods and supplies, such as a pair of doctor’s gloves, move from point of purchase to point of use. A reported one-third of hospital decision makers believe their hospital supply chain is functioning at maximum efficiency, but t...

How Healthcare Blockchain Can Help Overcome IT Barriers

HITInfrastructure The excitement surrounding blockchain’s possibilities for enterprise IT has predominantly centered on financial services. However, healthcare blockchain could also provide solutions to IT challenges facing healthcare organizations and consumers. There are several challenges in healthcare that blockchain could help with, including data exchange barriers, supply chain problems, and p...

Can Virtual Assistants Eliminate EHR Usability Pain Points?

EHRIntelligence The ubiquity of EHR technology in healthcare has done little to improve its reputation among its users. Despite efforts from federal regulators, industry associations, and healthcare leaders, providers across the care continuum are still struggling with huge amounts of frustration, stress, and burnout caused by interacting with EHR tools on a daily basis. Many industry leaders place the ...

What Is Deep Learning and How Will It Change Healthcare?

HealthITAnalytics Healthcare organizations of all sizes, types, and specialties are becoming increasingly interested in how artificial intelligence can support better patient care while reducing costs and improving efficiencies. Over a relatively short period of time, the availability and sophistication of AI has exploded, leaving providers, payers, and other stakeholders with a dizzying array of tools, t...

How to Comply with the HIPAA Breach Notification Rule

HealthITSecurity As more healthcare organizations face the daunting task of dealing with a data breach, more of them will have to become intimately familiar with the HIPAA Breach Notification Rule. The rule requires HIPAA covered entities and business associates (BAs) to provide notification to individuals, regulators, and the media following a breach of protected health information (PHI). But the devil,...

Developing Patient Teach-Back to Improve Patient Education

PatientEngagementHIT As healthcare costs continue to skyrocket, medical professionals know that a well-informed patient is a more engaged, healthier, and less costly patient. Critical to supplementing those efforts is ensuring patients understand a care concept. Patient teach-back has emerged as a key strategy for supporting patient education. Clinicians are encountering patient populations who largely don&r...

Combating Chronic Disease through the Social Determinants of Health

HealthITAnalytics Healthcare providers do their very best to understand everything they need to know about their patients during the few scant minutes they are able to spend with each individual.  Once or twice a year, or maybe when a sore throat strikes, providers collect data on current medications, chat about new problems, and order a prescription or two before sending the individual on his way. F...

Integrating a Telehealth Platform into a Diabetes Prevention Program

mHealthIntelligence Telehealth technology is helping to improve care management and coordination for the estimated 30 million Americans living with diabetes. Now, providers are moving into connected care technology to help more than 84 million at risk of acquiring the chronic disease. By using a virtual care platform and mHealth devices, providers can expand the range of the Diabetes Prevention Program (DPP...

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