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

Revenue Cycle Management Interviews

Prehabilitation Lowers Episode Costs Under Bundled Payment Models

by Jacqueline Belliveau

Dedicating even a couple hours to helping patients understand and prepare for a procedure prior to surgery can save providers millions under bundled payment models, explained healthcare industry expert and former CMS official Charlene Frizzera....

Reducing Low-Value Care Key to Value-Based Reimbursement Success

by Jacqueline Belliveau

Value-based reimbursement success hinges on decreasing low-value care across patient populations, explained Scott Weingarten, MD, MPH, Senior Vice President and Chief Clinical Transformation Officer at Cedars-Sinai Medical Center. While hospitals...

Consolidated Medical Billing Boosts Collections for a TX Group

by Jacqueline Belliveau

Providing a unified medical billing experience was key to improving patient collections by 24 percent in one year at the largest independent multi-specialty physician group in Abilene, Texas. Abilene Diagnostic Clinic boasts 30 physicians and...

Team-Based Care for Kidney Disease Saves Park Nicollet $1.2M

by Jacqueline Belliveau

End-stage renal disease comes with a hefty price tag for both patients and providers. But Park Nicollet Health Services, an integrated care system in Minnesota, found that a team-based care approach to late-stage kidney disease helped to drastically...

How Mercy Improved Care Transitions for Risk-Based Care Success

by Jacqueline Belliveau

For the thousands of patients released from their 23 acute care hospitals a year, Mercy Health ensures that each patient receives the highest value care. But there is only so much providers can do within the walls of their health system to extend...

Predictive Analytics Improve Nursing Schedules, Saving Mercy $4.3M

by Jacqueline Belliveau

Even with 40,000 physicians, nurses, and other employees, St. Louis-based Mercy still relied on staffing agencies and employee incentives to fill critical nursing schedule gaps until a predictive analytics platform helped operations leaders to...

Value-Based Contracts Rely on Patient Attribution, Data Sharing

by Jacqueline Belliveau

CMS aims to tie 90 percent of Medicare fee-for-service payments to quality by the end of 2018, with one-half of those payments to be paid under a value-based contract with some degree of financial risk. With ambitious goals from the federal government,...

Addressing Quadruple Aim, Physician Burnout Key to Risk Success

by Jacqueline Belliveau

From capturing patient risk to meeting quality measures, providers face a daunting list of items needed to achieve the Triple Aim of value-based care. But healthcare organizations will not see lasting cost savings and care quality improvements...

Automating Healthcare Contract Management Improves Business Ops

by Jacqueline Belliveau

Improving care access at hospitals is key to ensuring the health of pregnant women and their babies. But the business operations behind improving care access, such as employee and vendor contract management, must be as efficient as possible to...

The Pros and Cons of Quality Measure Choices In MACRA, MIPS

by Jacqueline Belliveau

Uprooting the fee-for-service payment system and changing the way clinicians provide care is no easy feat. With this in mind, CMS designed MACRA’s Merit-Based Incentive Payment System (MIPS) to gradually ramp up participation and offer...

Importance of Post-Acute Alignment, Integration to Value-Based Care

by Kyle Murphy, PhD

To achieve the ultimate goals of value-based care, healthcare organizations will need to assume greater responsibility over the patient’s experience across multiple care settings based on the appropriate level of acuity.   While the...

Full Risk Value-Based Care Key to Treating Vulnerable Patients

by Jacqueline Belliveau

Oak Street Health, a 24-primary care network headquartered in Chicago, aims to rebuild healthcare as it should be using value-based care contracts with full financial risk. The health system’s mission is to deliver personal, equitable,...

Health Centers Use Business Tactics to Compete with Private Orgs

by Jacqueline Belliveau

Federally qualified health centers (FQHCs) are the backbone of the healthcare safety net. But rising competition from hospitals and other healthcare organizations may be the straw that breaks that back. FHQCs receive enhanced Medicare and Medicaid...

Using EHR Systems, Supports to Aid MIPS Reporting, Boost Scores

by Jacqueline Belliveau

Delivering high-quality care is already a complicated process for healthcare providers. Understanding, as well as reporting, to MACRA’s Merit-Based Incentive Payment System (MIPS) has made the task even more complex, explained Brad J. Abrams,...

Provider Data Integrity Key to Directory Accuracy, Value-Based Care

by Jacqueline Belliveau

Providers and their payers oftentimes have a love-hate relationship. Payers boost the number of patients walking through physician office doors using provider directories as well as reimburse providers for treating those patients. But navigating...

Physician Advisors Crucial to Navigating Reimbursement Rules

by Jacqueline Belliveau

When physicians are asked why they went into medicine, the classic response is that they wanted to help people. But as value-based reimbursement takes hold and clinical documentation demands increase, providers are finding that the business of...

CO’s Pediatric Care Network Brings Value-Based Care to Children

by Jacqueline Belliveau

Medicare has led the healthcare industry as it shifts from fee-for-service to value-based care, with 30 percent of traditional Medicare reimbursements already paid under an alternative payment model. The federal government plans to further transition...

MIPS Quality Reporting Flexibilities Trouble Providers, EHR Vendors

by Jacqueline Belliveau

It’s good to have options when it comes to the clothes we wear, cars we drive, and things we do. But having too many options when it comes to quality reporting under MACRA’s Merit-Based Incentive Payment System (MIPS) may prove to...

Bringing Back House Calls to Cut Spending on High-Risk Patients

by Jacqueline Belliveau

Before the early 1960s, the majority of healthcare visits were performed in patient homes. But as healthcare evolved, providers could no longer fit their tools in a transportable medical bag and the proportion of visits made by house calls dropped...

How Palomar Health Created a High-Value Post-Acute Care Network

by Jacqueline Belliveau

Ensuring patients receive high-value care delivery during their hospital stay or office visit is a top priority for healthcare providers. But value-based purchasing models are pressuring doctors to extend that same cost-efficient, high-quality...

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