Coordination is key to the online retail industry. From the moment you click “order” on Amazon or Walmart.com, the retailer instantly starts packaging and mailing your item, providing you with each step the package takes until...Crow is the president of Catalyst Health Network, an accountable care organization of independent primary care physicians based in Dallas, Texas that has recently saved $50 million through its efforts to bring the same level of coordination...
Last week, CMS Administrator Seema Verma reported that CMS approved the applications for 53 new accountable care organizations (ACOs) to join the Medicare Shared Savings Program (MSSP) starting on Jan. 1, 2020. But an industry expert is...
For an academic health system with 8,000 employees and $2.9 billion in revenue, running an efficient revenue cycle is paramount. Nebraska Medicine is a large academic health system with two hospitals and about 40 specialty and primary care...
Physician practices and hospital outpatient clinics treat a similar number of commercially insured patients needing physician-administered drugs, but hospitals receive a larger share of the gross profits, according to a recent analysis by...
Each stakeholder brings their own definition of value to the table when developing alternative payment models, which incent providers through value-based payments to deliver care that aligns with the agreed-upon definition of value....“If you don't get feedback early on about what really matters or what the value equation is for patients and their families, then we're just stabbing in the dark in terms of quality measurement and the associated payment...
At a time when operating income is falling for most hospitals and practices, Atrius Health, Inc., the largest non-profit independent medical group in New England, is reporting a $38.7 million operating surplus. And risk-based payments are...
Recent healthcare price transparency rules have pulled back the veil on the hospital chargemaster, calling into question hospital chargemaster management best practices. Once considered a trade secret by most, the hospital chargemaster is...
Prior authorizations used to be one of the greatest pain points for providers at Advocate Aurora Health. While most physicians recently surveyed by the American Medical Association (AMA) said they wait about one business day to receive...“Prior authorizations, whether for medications or services, were a nightmare for us,” the former senior vice president of regulatory compliance at Advocate Aurora Health told RevCycleIntelligence.com. “Clinic staff had to...“We thought, ‘What functions are available once our pharmacy does go live on the system? What do we have available to us?’ One of the functions we saw was the electronic prior authorization.” From there, Hardin...
Patient collections is a significant undertaking at Allina Health, a 12-hospital system with over 90 clinics, 52 rehabilitation facilities, and dozens of other care sites across Minnesota and western Wisconsin. The not-for-profit health...
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...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...
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...
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....
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...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...
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...
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...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...
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...“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...
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...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...“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...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...
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...“Doctors go to school to learn how to take care of patients,” she recently told RevCycleIntelligence.com. “They do not go to school to learn governmental and payer rules for things like whether or not billing is...
Since the Obama administration signed MACRA into law in 2015, healthcare providers have been attempting to understand the Quality Payment Program and its Merit-Based Incentive Payment System (MIPS). But regular updates and tweaks to MACRA...Understanding the changes while keeping track of performance periods for the Quality Payment Program’s value-based reimbursement tracks have proved to be an obstacle for providers, Rebecca Altman, Managing Director at Berkeley...Altman recommended that practices across the size spectrum identify one to two physicians to become experts in MACRA implementation and Quality Payment Program requirements. “It is hard to get physicians to take time out of seeing...While the additional time may help practices of all sizes implement the resources necessary for quality measurement and reporting, Altman argued that it may not be enough to truly help small practices prepare. “They have bumped the...Hardwiring quality measure checklists that align with MIPS is key to maximizing performance scores and earning a value-based incentive payment rather than a penalty. “Folks need to really optimize and utilize their EHR to hardwire...
Revenue cycle management remains relatively elusive in the new healthcare landscape, as new regulations and reforms have led the industry to evolve and left many hospitals scrambling to keep their revenue strong in a value-based care...
