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

Revenue Cycle Management Interviews

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...

Paperless Medical Billing Key to Boosting Patient Collections

by Jacqueline LaPointe

In the age of smartphones, tablets, and other technologies that put information literally in the palm of our hands, why do doctors still rely on paper to reach their patients for medical billing purposes? That was the question Max Tselevich...The digital revolution at The Doctor allowed patients to use technology to book appointments, check-in, access their medical records, request prescription refills, and update their patient portal information. But the technological advanceme...

Revenue Cycle Management Integration Boosts the Bottom Line

by Jacqueline LaPointe

When you ask a provider which EHR system he uses, you expect to hear a single vendor, such as Epic, Cerner, or MEDITECH. But when you inquire about a provider’s revenue cycle management system, you are likely to get a laundry list of ...“We've been watching Cerner and their revenue cycle product to see how it matured, developed, and stabilized over the course of time,” he said. “We made the decision about three years ago to re-visit it. We did a forma...

How Hospitals Bring in Revenue Through the Healthcare Supply Chain

by Jacqueline LaPointe

The healthcare supply chain is a cost center for provider organizations of all sizes. Through the supply chain, healthcare organizations spend money on the items and supplies they need to deliver the services that bring in revenue. As a res...

WA Makes Healthcare Price Transparency Consumer-Friendly

by Jacqueline LaPointe

How much does a knee replacement surgery cost at MultiCare Auburn Medical Center in Auburn, Washington versus St. Anthony Hospital in nearby Gig Harbor? Does EvergreenHealth Medical Center in Kirkland deliver the highest value birthing expe...“A lot of them have experiences in other states, so they're familiar with the way intake and submission work,” she added. “They've been through the process of the state mandating the submission. It actually was a f...

Quantifying Financial Distress to Stop Hospital Bankruptcy, Closure

by Jacqueline LaPointe

More healthcare organizations will face financial troubles, and possibly a hospital bankruptcy or closure, in the coming years as the healthcare industry undergoes major changes. Changes that will result in lower reimbursement rates, more c...The Z-score is a weighted composite score of four types of ratios, Langabeer and his research team explained. The score accounts for financial leverage, profitability, liquidity, and capital structure, which can all be found on hospital bal...“The variable X1 represents net working capital (e.g., current assets less current liabilities) ÷ total assets. The variable X2 represents retained earnings ÷ total assets. Variable X3 is earnings before income taxes &di...“But fundamentally CFOs needs to get involved with figuring out how to manage their business differently. How do we restructure our service lines? How do we partner with different facilities? How do we get better referral networks fro...

When Should Providers Consider a Strategic Hospital Acquisition?

by Jacqueline LaPointe

For many small hospitals, remaining independent as the healthcare industry hurdles toward value-based purchasing, population health management, and other transformations is a source of pride even if the organization has one foot in the fina...“Long-term, that's worse for their patients and for their communities,” he continued. “They wait until they are running out of cash and they start looking like the Alamo. You don't want to be in a position where Sa...

Finding a Revenue Cycle Management System for Post-Acute Care

by Jacqueline LaPointe

Post-acute care has become a major focus as providers, payers, and policymakers attempt to cut healthcare costs and improve long-term patient outcomes. However, the revenue cycle management space is dragging its feet when it comes to making...Revenue cycle management systems lack the sophistication to manage medical billing across several post-acute care facilities because they were designed for other healthcare facilities, Morris elaborated. “A lot of the products that ar...

A Provider-Sponsored Health Plan Is A Hospital’s Natural Next Step

by Jacqueline LaPointe

Many hospitals and health systems are bypassing the ultimate opportunity to gain greater control of the outcomes and costs of their patients. That opportunity is developing their own provider-sponsored health plan, according to Geisinger He...“There's a lot of different forms of risk-taking that can occur,” he elaborated. “You can think about it on a final payment basis. You could think about it on a total cost of care basis. The other would be like what we...

Providers Investing in Home Health to Prepare for Aging Population

by Jacqueline LaPointe

Faced with the pressure to reduce healthcare costs as the elderly population rapidly grows, providers plan to shift elder care from hospitals and skilled nursing facilities to the home, healthcare experts explained. According to CMS and Cen...

Quality Improvement Projects Save Children’s Hospitals Millions

by Jacqueline LaPointe

Care quality improvements require hospitals to invest their money, time, and staff. The investment may be large, but for two children’s hospitals it paid off, saving the organizations millions and reducing costly accidents and unneces...“One of the very first things we did was provide asthma control tests, which is a validated tool to screen for asthma control,” he said. “Our goal was to provide that at each visit in which we saw a patient with asthma reg...“It started by trying to measure harm. We didn’t have any idea how often that was happening. So, the first thing was to create a system for how we were going to categorize harm and then start to measure that,” he said. The...

Healthcare Mergers, Increased Access to Boost Medical Costs 6%

by Jacqueline LaPointe

PwC’s Health Research Institute (HRI) predicts medical costs for employers to grow 6 percent in 2019 as healthcare mergers and more convenient care access options drive up healthcare costs and utilization. The medical cost trend is co...Healthcare mergers and consolidation will not help the healthcare industry drive down medical costs to a sustainable rate, revealed the HRI analysis of the employer-based market, which covers approximately one-half of non-elderly Americans....This boost in healthcare utilization will temporarily increase costs, Gniewek explained. “The shocker on the inflator side is really the care anywhere factor and the idea that we wanted to make healthcare easier. But whenever you make...

Automated Physician Queries Improve Clinical Documentation at WMHS

by Jacqueline LaPointe

Accurate claims reimbursement hinges on complete clinical documentation, and therefore, quick responses to physician queries regarding medical record documentation and coding. This is especially true in Maryland’s unique hospital reim...“This whole process usually took anywhere from three days to sometimes up to three or four weeks,” Davidson elaborated. And physician query response rates hovered between 62 and 65 percent, impacting several of the health system...

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