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

Revenue Cycle Management Interviews

NY Group Rethinks Physician Consolidation to Add Long-Term Value

by Jacqueline LaPointe

Physician consolidation, value-based care, and other market pressures are sounding the death knell for many small and independent practices. Less than a third of physicians owned an independent practice in 2018, according to a Physicians Fo...“There are opportunities to streamline and standardize services through some type of central business structure, whether that be an MSO, a statutory merger, IPA, or some other vertical integration,” suggested Deepak Kapoor, MD, ...

How Practices Can Benefit from Healthcare Price Transparency

by Jacqueline LaPointe

In 2019, CMS mandated all hospitals in the US to publish a list of their standard charges online. The federal agency intends for healthcare price transparency to empower patients to make more cost-conscious decisions when it comes to their ...“Without that, the only way I knew what the hospital fees were was if our patient went to the hospital. We probably do between five and seven percent of our cases in the hospital outpatient department because of the patient's como...

Rethinking the Claims Clearinghouse Relationship Helps Hospitals

by Jacqueline LaPointe

A growing network of post-acute care hospitals based in Pennsylvania recently achieved a near perfect clean claims rate and uncovered $12 million in inappropriate payer denials after switching its claims clearinghouse vendor. Vibra Healthca...“It seemed more like a basic system and at my level, I was able to see claim denials,” he added. “But what kind of denials we were getting, what they were for, what percentage they were compared to others, and what we were...

Bots Make Claim Status Inquiry More Efficient for Avera Health

by Jacqueline LaPointe

Robots in healthcare do not have to be large human-like machines that replace providers. But bots embedded in software applications can be a key tool for reducing the burden of mundane, common tasks, such as claim status inquiry. At least t...Not wanting to add to the system’s labor costs, which can account for up to 60 percent of a hospital’s operating expenses, Wickersham looked into how technology could aid Avera’s lagging revenue cycle. “I had heard a...

Post-Acute, At-Home Care Saves Next Gen ACO Atrius Health $19.9M

by Jacqueline LaPointe

“You can't emphasize enough the right setting and the right care,” stressed Peggy Chou, MD, the Senior Medical Director of Performance Excellence of Atrius Health in Massachusetts. Atrius Health is a non-profit system of 32 ...Chou explained that Atrius, one of the original 32 Pioneer ACOs, had a successful first year in the Next Generation program because of the organization’s commitment to delivering the right care in the right setting. “It’s ...

Major Health Systems Create New Company to Tackle Drug Shortages

by Jacqueline LaPointe

Drug shortages are preventing hospitals from providing even the most basic care to patients. In a recent study by the National Opinion Research Center (NORC) at the University of Chicago, approximately 80 percent of hospitals found it chall...But pharmaceutical manufacturers and companies are not the only stakeholders at fault, he stressed. “The way health systems contract with manufacturers or group purchasing organizations for drugs is another facet of the drug shortage ...

Small Hospital Boosts Bottom Line Through Patient Access Automation

by Jacqueline LaPointe

“The patient access area is where everything starts, and that mindset is what led to our success.” That was the sentiment of Deonne Henry, the Vice President of Revenue Cycle at Magnolia Regional Health Center in Mississippi. Th...In light of the challenges, Henry started to look for a revenue cycle management technology that could automate patient access, deliver data and insights to leadership, and improve the hospital’s bottom line. “We wanted to get t...

Social Determinants of Health Key to Value-Based Purchasing Success

by Jacqueline LaPointe

We are quickly heading to the value-based purchasing tipping point, according to the Vice President of Network Management at Health Partners Plans in Pennsylvania. “While adoption rates are still relatively low in some regions of the ...“I've been a part of the value-based purchasing space for the past at least 12 years, if not more,” he explained. “At that time, social determinants weren’t even a part of the conversation. It wasn't even a p...

Accounting for the Patient in the Healthcare Revenue Cycle

by Jacqueline LaPointe

From value-based care to record-high levels of patient financial responsibility, the healthcare industry is undergoing a tremendous amount of evolution. And the healthcare revenue cycle is having to learn some new tricks to keep up. Top of ...Automating patient data collection will also help Abilene to collect patient information correctly the first time. “Having that information filled out electronically beforehand by the patient captures their data points so much better ...

Investing in Primary Care Delivers Value-Based Care Results

by Jacqueline LaPointe

Supporting primary care will bring value-based care results, asserts Humana’s Chief Medical Officer Roy Beveridge, MD. Value-based arrangements between providers and payers have the lofty, yet admirable goals of improving care quality...“Who do you think is accountable? Well, it's the primary care physician. Who's the one who's making the hard decisions? And who's the one who's answering the telephone call Friday at 4:00 a.m. and Saturday at 10:00...

Aligning the Healthcare Revenue Cycle with Patient Experience

by Jacqueline LaPointe

Improving a patient’s financial experience is key to healthcare revenue cycle management success, according to the Senior Regional Director of Revenue Cycle at Ascension Healthcare. “Moving into the future, we need to focus more...“Online pre-registration is another technology-supported service healthcare organizations should be focused on right now,” he added. Self-service tools will transform healthcare into a more retail-like experience. But the tools ...

Looking Beyond Price in the Healthcare Supply Chain to Add Value

by Jacqueline LaPointe

Don’t equate value in the healthcare supply chain with just price, Premier, Inc’s Myla Maloney recently advised healthcare stakeholders at Xtelligent Healthcare Media’s Value-Based Care Summit in Boston. “Price matte...

Putting Both Feet in the Value-Based Care, Reimbursement Boat

by Jacqueline LaPointe

“Do not put each foot in a different boat,” warned Partners HealthCare CFO Peter Markell at Xtelligent Healthcare Media’s third annual Value-Based Care Summit in Boston. But the current reality in healthcare is that provid...With managing the outcomes of all three care groups, providers must simultaneously think of care appropriateness. “Appropriateness is actually the most important driver of the cost discussion in the US,” he said. “You coul...

4 Hospital Business Models for Consumer-Centric Healthcare

by Jacqueline LaPointe

When a member of Gurpreet Singh’s family broke his wrist, they didn’t go to a hospital emergency room or an academic medical. Instead, the family headed to an urgent care center to triage the situation and develop a care plan. T...

Aligning Incentives for Providers, Payers Improves Primary Care

by Jacqueline LaPointe

How the healthcare industry delivers and pays for primary care is changing as the country finds their healthcare spending skyrocketing. Healthcare spending across the country is slated to increase at an average annual rate of 5.5 percent ov...“We’re extremely intentional about aligning financial interests for our clients, our clinicians, our entire staff, and our patients themselves,” he added. Vera and Blue KC intentionally aligned the financial incentives for...“We have incentivized those pieces so that Vera and Blue KC look at it in the same lens,” he continued. By aligning the financial incentives, providers no longer have to depend on service volumes to ensure they can continue deli...

End-to-End Revenue Cycle Management Key to Success at Ascension

by Jacqueline LaPointe

The healthcare revenue cycle contains many moving parts. Hospitals and health systems typically rely on a patchwork of technologies and best practices to ensure everything from patient access and registration to medical billing and collecti...But sharing services to streamline the revenue cycle and care delivery can be difficult when hospitals in a health system each have their own way of operating. The variation can also influence other aspects of care outside of the reven...

New Alternative Payment Model Tackles Holistic Addiction Recovery

by Jacqueline LaPointe

A national multi-sector alliance of healthcare industry leaders is looking to incentivize providers and payers to deliver coordinated, holistic addiction recovery services to patients through a new alternative payment model. Nearly 21 milli...At the center of the care recovery team is a care coordinator. The clinically-trained care coordinator will serve as the point-of-contact for the patient and providers. The individual will also coordinate the services for holistic addiction...Under the two episodes, providers in the network will receive the first type of value-based payment from payers. The payment is a blend of capitated and bundled reimbursement, Pollock explained. “The payment is capitated in the sense ...

RCCH Uses Predictive Analytics to Boost Claim Denials Management

by Jacqueline LaPointe

Predictive analytics are key to implementing an effective and efficient claim denials management strategy that tackles the right denials at the right time, according to the Vice President of Revenue Cycle at Tennessee’s RCCH Healthcar...

Artificial Intelligence Ensures Payer, Provider Pay Covers Costs

by Jacqueline LaPointe

Artificial intelligence (AI) in healthcare is influencing the next generation of radiology tools and helping to expand access to care in underserved or developing areas. The technology is supporting clinical advancements, but a Pennsylvania...With risk adjustment now a critical component to health plan and provider payment determinations, accurate and complete clinical documentation is a top priority for health plans and providers alike. Providers need to make sure documentation...

Using Text Messages to Improve Healthcare Recruitment, Employment

by Jacqueline LaPointe

Getting qualified healthcare professionals in the door for interviews as quickly as possible is paramount for provider organizations facing a competitive healthcare recruitment and employment market. The healthcare industry is in the midst ...“If we were to find your application and we want to talk to you about a nursing position, then we would traditionally pick up the phone or send an email,” Sendelweck explained. “Turnaround times can especially vary for nur...

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