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

Revenue Cycle Management Interviews

Preparing Providers for the Healthcare Consumerism Shift

by Jacqueline LaPointe

With a couple of swipes and clicks, patients are driving the shift to healthcare consumerism in the palm of their hands. But many healthcare organizations are not finding it as easy to align their care delivery and patient collection strate...To learn more about healthcare consumerism, many healthcare providers packed their bags and made their way to sunny Florida to attend HIMSS17. As one of the hot topics at this year’s conference, sessions covered everything f...Expenditures, electronics, and engagement push on healthcare consumerism As healthcare consumerism takes hold of the industry, patients are no longer just considered a walking condition to the provider, Betts explained. Instead, providers s...Building more humanity into the healthcare experience Sprawled across Deloitte’s booth were the words engage, transform, and reimagine. This is where Betts suggested that healthcare organizations start with aligning care with healthca...Evaluating the healthcare experience To understand if a more retail-oriented approach to healthcare improves the patient experience, healthcare organizations should use a range of measures to test their strategy, including standardized staf...

Payer, Provider Dialogue Key to Prior Authorization Reform

by Jacqueline LaPointe

ORLANDO - Prior authorization reform has recently been a hot topic for many healthcare industry groups and it was no different at HIMSS17. To find out more about what providers and payers plan on doing to alleviate the administrative and ca...

How a Rural Hospital Used Health IT, EHR to Stay Independent

by Jacqueline LaPointe

In a time of declining claims reimbursement rates and value-based care, rural hospitals are struggling more than ever to improve their healthcare revenue cycle management strategies. For many rural hospitals, the decision oftentimes comes d...A 14-bed critical access hospital in Idaho, however, recently beat both hospital merger and closure odds by investing in cloud-based health IT solutions to improve their healthcare revenue cycle management strategies. “If a ...Huerta described the hospital’s situation as turning the clock back 20 years. “We didn’t have wifi,” he said. “We didn’t have fiber. We literally had copper wires for our phone system. When I got to the h...The Idaho-based critical access hospital, however, strived to remain independent. The hospital’s CEO described the organization as “stand-alone” and “fiercely independent,” which contributed to the hospital&rsq...Additionally, the cloud-based EHR and medical billing solutions enabled providers and other staff members to access clinical and financial data across the care continuum, resulting in revenue boosts. “Now we have the clinic, emergency...

ACO Incentives, Coordination Improve Complex Pediatric Care

by Jacqueline LaPointe

Children with medical complexities, or children who require the highest level of service and support, are one of the most expensive pediatric patient populations. But provider collaboration and financial incentives through an accountable ca...Using a CMS Innovation Center grant to expand their ACO, however, Noritz and his team at Nationwide Children’s Hospital in Ohio developed a care delivery model to improve outcomes and reduce costs for some children with medical comple...In the December 2016 study in Pediatrics, Noritz and other program leaders attributed the program’s success to the financial incentives provided through an ACO model because the incentives promoted care coordination. Noritz elaborated...As part of their smarter healthcare culture, Nationwide Children’s also hired care coordinators for the duration of the initiative. Using the grant, Noritz and his team demonstrated to the hospital that care coordination eff...

Flexibility Key to Revenue Cycle Management Vendor Selection

by Jacqueline LaPointe

With thousands of healthcare revenue cycle management and business intelligence analytics vendors in the market, how does a provider organization decide on just one? According to Robert Creaven, CMPE, MPA, Executive Vice President of Operat...

How a Small Hospital Increased Patient Collections by 300%

by Jacqueline LaPointe

As patient financial responsibility continues to increase in a more consumer-focused healthcare environment, more hospitals are shifting healthcare revenue cycle management strategies to improve patient collections. Iroquois Memorial Hospit...

Using an Alternative Payment Model to Reduce Hospitalizations

by Jacqueline LaPointe

Are clinical interventions enough to alter provider behavior to align with value-based care? Or are providers more motivated to change because of financial incentives under alternative payment models? CMS recently partnered with the Univers...

Key Ways to Succeed Under MACRA’s Quality Payment Program

by Jacqueline LaPointe

Do not feel overwhelmed by the upcoming Quality Payment Program, a healthcare expert at CAPG, a non-profit trade association for accountable physician organizations, advised the projected 592,000 to 642,000 eligible clinicians participating...

Benefits, Challenges of Value-Based Health IT Implementation

by Jacqueline LaPointe

From EHR systems to mHealth apps, health IT has the potential to help providers achieve value-based care goals. But with hundreds of new technologies seemingly emerging each day, many providers are struggling to select the most appropriate ...

Ensuring Success in the Transition to Value-Based Care

by Kyle Murphy, PhD

Most recently, the Department of Health & Human Services issued a final rule for the Quality Payment Program as part of implementing provisions of the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015. The program comprising ...

How MACRA Implementation Rules Affect Provider Profitability

by Jacqueline LaPointe

New value-based reimbursement models under the Quality Payment Program will launch on Jan. 1, 2017, leaving a couple of months for providers to educate themselves on MACRA implementation rules and prepare their practices for the shift. But ...

How Value-Based Reimbursement Affects Physician Productivity

by Jacqueline LaPointe

As payers push for more value-based reimbursement adoption, many healthcare organizations are wondering how to restructure physician productivity strategies to meet the unique requirements of performance-based payments. But the key to succe...

Lessons Learned from the First Year of ICD-10 Implementation

by Jacqueline LaPointe

With the anniversary of ICD-10 compliance approaching, many providers are looking back on the past year to see how the new coding system has affected their organizations as well as preparing for fast approaching updates. At Baptist Health S...

How Pioneer ACOs Earn Shared Savings, Improve Care Quality

by Jacqueline LaPointe

Massachusetts-based Atrius Health successfully managed several care quality improvements over the previous year and earned both the recognition of CMS and a portion of shared savings as a participant in the Pioneer ACO Model program. In Aug...

How a Small Hospital Developed Lean Supply Chain Management

by Jacqueline LaPointe

When hospitals start to dig into how their organizations can reduce healthcare costs without lowering care quality, many run the risk of overlooking several cost-cutting opportunities in their healthcare supply chain management process. But...

Strong Compliance Programs Key to Avoiding Healthcare Fraud

by Jacqueline LaPointe

Preventing and catching healthcare fraud schemes has recently jumped to the forefront of many public and private payer programs that are designed to reduce unnecessary healthcare spending. The Department of Health and Human Services (HHS) a...

The Future of Accountable Care Organizations Involves Risk

by Jacqueline LaPointe

As many healthcare providers know, participating in a value-based care program, such as an accountable care organization, is about more than just tying payment to quality.  It involves shouldering financial risk as a way to motivate cl...

Top 5 Ways to Optimize Healthcare Revenue Cycle Management

by Vera Gruessner

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 reimbu...

Acquisitions, Scale Key to Pediatric Revenue Cycle Management

by Jennifer Bresnick

Stanford Children’s Health may be best known for delivering expert acute care to pediatric patients and expectant mothers at the flagship Lucile Packard Children’s Hospital, but inpatient services are only a part of how the syst...

How to Scale Healthcare Bundled Payments throughout Hospitals

by Vera Gruessner

Healthcare bundled payments are a key strategy across the industry aimed at boosting patient health outcomes, improving the quality of care, and bringing reimbursement toward a value-based payment model. While the Centers for Medicare &...

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