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

Revenue Cycle Management Interviews

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...

Giving GA Hospitals Healthcare Cost Data to Lowering Spending

by Jacqueline LaPointe

With claims reimbursement rates falling and competition among healthcare organizations intensifying, hospitals are calling on their providers to increase efficiency and reduce healthcare costs for each admission. So, what do providers need ...But merely dumping a plethora of healthcare cost and quality data into a provider’s hands was not the route Wylie aimed to take. He emphasized how providers should be able to access healthcare cost data that helps them choose the most...

Payment Plans Key to Collecting Patient Financial Responsibility

by Jacqueline LaPointe

With the rise in popularity of high deductible health plans, hospitals are no longer waiting on just payers to collect what is owed to their hospital or practice. Patients have become a major revenue source, but hospitals are struggling to ...“For example, when we looked across the spectrum as far as collection performance goes, we were collecting approximately 5 percent on self-pay and about 30 percent on the balance after insurance. Not great outcomes.” With patien...

Addressing Productivity, Labor to Bend the Healthcare Cost Curve

by Jacqueline LaPointe

From alternative payment models and value-based purchasing to artificial intelligence and data analytics tools, the healthcare industry is transforming how care is delivered and paid for to reduce constantly rising medical costs. While paym...

“Just the Beginning” of Healthcare Price Transparency, Verma Says

by Jacqueline LaPointe

Requiring hospitals to post a list of their standard charges online is just the beginning of the push for increased healthcare price transparency by CMS, explained the federal agency’s Administrator Seema Verma. “As people are p...In addition to general healthcare price transparency questions, CMS is also seeking comments on understanding the out-of-pocket costs for patients with Medigap coverage. The RFI echoes a recent push for healthcare price transparency informa...

Gaining Visibility into Healthcare Workforce Management Cuts Costs

by Jacqueline LaPointe

If it takes a village to raise a child, then it may take an entire city to operate a health system. From executives and clinicians to IT managers and front desk staff, healthcare workforce management involves hundreds to thousands of employ...“There's been so much consolidation that they don't have a clear picture of their entire workforce,” he remarked. “They may have the data in four different databases or they may have time management in one system, ...

RFID, Smart Cabinets Improve Hospital Supply Chain Management

by Jacqueline LaPointe

From EHR systems and revenue cycle management tools to data analytics and online patient payment options, hospitals and health systems are on the journey to automating all aspects of the healthcare experience. However, the hospital supply c...

Real-Time Insights into Nursing Workflow Maximizes Productivity

by Jacqueline LaPointe

An elderly patient presses the nurse call button to get assistance with standing up and using the toilet, while another patient in the next room presses the button to get help with changing the TV channel. Further down the hall, lights turn...“From their room, the patient is able to call their nurse directly without going through a unit secretary or a unit clerk,” Bedgood explained regarding the new system. “They can hit a button and it will ring a phone in the...

OR Efficiency, Machine Learning Boosts UCHealth’s Revenue by $10M

by Jacqueline LaPointe

Moving from traditional block scheduling for the operating room (OR) to more of a service-based system that used machine learning maximized OR efficiency and increased revenue by $10 million across UCHealth’s University of Colorado Ho...But not all the surgeons needed that eight-hour block. “Some people will use four-hour chunks and only operate half the day,” he said. The hospital needed a service-based approach that was more flexible than block scheduling and...“What that meant was the operations team and surgeons would have to sit down and stare at this data and try to make sense of it,” he continued. “They had the data, but it was all about what happened in the past and not abo...

Bringing Profee, Facility Together to Maximize Coding Productivity

by Jacqueline LaPointe

Professional and facility coding describe two very different aspects of a healthcare. But breaking down the wall between the departments has the potential to boost coding productivity and improve clean claim rates. While professional codes ...“If it lacks the specificity that’s required, it could bump up against an NCCI edit, which is the National Correct Coding Initiative edit,” she said. “Or, it could interact with a medical necessity rule if the proced...

Transforming the Hospital Laboratory into a Profit Center

by Jacqueline LaPointe

Hospital and health system executives are missing an opportunity to maximize revenue cycle and operational success by viewing the hospital laboratory as a cost, rather than profit, center, explained Charles Wilson, MHA, Vice President of Op...Hospital and health system executives are increasingly selling their outreach programs to national commercial laboratories. Stories like Quest Diagnostics acquiring the laboratory outreach operations for two hospitals of the Hartford Health...“But that is a poor decision to make because you don’t want to look at it as what you can save me in regards to what my costs are,” he explained. “You should be looking at it as to the potential for revenue generatio...A laboratory-specific platform was also key to handling a large number of claims being created through the outreach program, Wilson stated. “As you start to add up all of those high volume, low margin denials, you find out that that i...

A Holistic View of the Patient Enables Risk-Based ACO Success

by Jacqueline LaPointe

Giving providers a holistic view of the patient resulted in accountable care organization (ACO) success for a risk-based organization in southern Florida, which earned a place on the list of ACOs achieving the greatest shared savings in the...But gathering the data needed to understand a patient’s care is just the first step. “We have copious amounts of data that we have to put into a single platform and be able to actually understand and to drive results from,&rdquo...

Slow and Steady Still the Motto for Value-Based Reimbursement

by Jacqueline LaPointe

The healthcare industry has boarded the train to value-based reimbursement. But recent roadblocks have provider organizations pumping the brakes with the shift away from fee-for-service, explained industry experts Doral Jacobsen, MBA, FACMP...

Patient Education Boosts Revenue, Quality for Joint Replacements

by Jacqueline LaPointe

Offering interactive patient education pre- and post-total joint replacement surgery is key to improving patient outcomes and generating new revenue, a multi-specialty hospital system in the Twin Cities area recently found. An estimated 7 m...“If we can impact same-day surgery cancels, we can impact that revenue potential,” he continued. “When you look at what makes people do same-day surgery cancels, they’re things like infection and uncontrolled diabete...

Prehabilitation Lowers Episode Costs Under Bundled Payment Models

by Jacqueline LaPointe

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 Frizz...“What the surgeons did was say to a patient that if you don't do these things, your surgery will not be successful,” she continued. “Instead of telling the patient you have to lose weight or you shouldn't smoke, bu...

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

by Jacqueline LaPointe

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 hos...“According to the literature and the information we can find, if we’re really going to make a substantial leap forward in our efforts to both improve quality of care and affordability of care, we have to focus on reducing low-va...

Consolidated Medical Billing Boosts Collections for a TX Group

by Jacqueline LaPointe

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 a...“From my standpoint, there was an opportunity,” he explained. “It wasn’t really affecting the revenue number as much, but it was more the cash was just hanging out there, and we weren’t doing a good job of coll...

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