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

Revenue Cycle Management Interviews

Key Capabilities for Population-Based Alternative Payment Models

by Jacqueline LaPointe

To succeed in population-based alternative payment models with two-sided financial risk, health systems should embrace assuming the role of the payer and work to get all staff on board with the model, suggested Jackie Selby, a healthcare an...Population-based alternative payment models, such as capitation payments, require providers to assume the majority of financial and clinical risk for select patient groups. The models aim to incentivize providers to improve care quality whi...A major capability health systems need to successfully implement population-based alternative payment structures is a large patient population. “There is no one population size that's ideal for population health, but the large is ...“They're acting like the health plan for a portion of the population,” she pointed out. “The network that they have has to be robust enough to have all the services available. It must also have access to all those prov...Providers oftentimes face utilization management requirements, such as prior authorizations and step therapy, when submitting claims to payers. However, health systems participating in population-based alternative payment models may want to...

Credit Card On File Program Key To Patient Collections Success

by Jacqueline LaPointe

Implementing a credit card on file program boosted patient collections and reduced accounts receivable by 28 percent in six months at Orthopaedics & Rheumatology of the North Shore, a four-physician specialty practice in Illinois. Consu...While premiums were lower, out-of-pocket costs significantly increased. Consumers have paid 255 percent more in out-of-pocket costs since 2006 as a result, according to a 2015 Kaiser Family Foundation study. “In 2016, these high-deduc...If patients do not have a credit or debit card, staff currently ask for a retainer of $200 cash or check for Medicare patients. The retainer jumps to $500 for commercially insured patients. At first, Rogers and her associates feared that so...

MIPS Reporting Success Depends on Choosing Suitable Measures

by Jacqueline LaPointe

For Merit-Based Incentive Payment System (MIPS) reporting success, eligible clinicians should report on quality measures that they know their practice already performs well on, advised Michael Abrams, MA, a managing partner at the healthcar...Ready or not, CMS launched MACRA’s Quality Payment Program at the start of the year. As the most popular value-based reimbursement track under the program, most eligible clinicians will need to report on some MIPS performance data in ...However, Abrams explained that using a composite score to evaluate and reimburse providers may come with some challenges. “The issues that are likely to arise relating to a composite score in MIPS are similar to those that came up in ...“One would hope that over time providers who don’t score as well or who learn that their performance relative to performance of their peers is not as strong as they thought will use that information and use that opportunity to t...

Bundled Payment Models Here to Stay Despite CMS Program Delays

by Jacqueline LaPointe

CMS may have issued three-month delays for several new healthcare bundled payment models, but providers should still anticipate the shift to value-based purchasing through the episodic alternative payment model, said Colin Luke, a partner a...For providers, this is the second delay for several CMS bundled payment models, including the Comprehensive Care for Joint Replacement pilot (CJR), the Cardiac Rehabilitation Incentive Payment Model, and three other Medicare cardiac care pa...

How to Prepare for Alternative Payment Model Implementation

by Jacqueline LaPointe

Implementing interoperable health IT infrastructure and a staffing model that aligns with value-based care requirements are key to successfully participating in an alternative payment model, Marjie Harbrecht, MD, a Medical Group Management ...As the federal government and policymakers continue to shift the healthcare industry away from fee-for-service payment structures, providers are feeling the pressure to take on more financial risk for the care they deliver under alternative...But the uncertainty over return on investment has kept some providers from making the jump to more robust alternative payment model adoption, she pointed out. “From the provider perspective, if they’re going to make the upfront investments ...Many care delivery and alternative payment models, such as patient-centered medical homes and accountable care organizations, emphasize the role of the primary care provider. Under these models, primary care providers should act as the care...

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...

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