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

Best Practices

How Accountable Care Organizations Can Prepare for Downside Risk

March 14, 2019 - Accountable care organizations (ACOs) are part of the foundation of the healthcare industry’s transition to value-based care and purchasing. Since the passage of the Affordable Care Act (ACA), ACOs have realized clinical and financial improvements. Organizations in the Medicare’s largest ACO program average a quality performance score north of 90 percent, and CMS estimates...


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3 Strategies to Minimize the Burden of Prior Authorizations

by Jacqueline LaPointe

Prior authorizations, or prior approvals, are strategies that payers use to control costs and ensure their members only receive medically necessary care. The cost-control process requires providers to acquire advance approval from payers...

How Addressing Social Determinants of Health Cuts Healthcare Costs

by Jacqueline LaPointe

Population health management and value-based reimbursement success hinge on reducing healthcare costs not only when a patient is in the exam room, but also when they are beyond the walls of the practice or hospital. Therefore,...

4 Strategies for Providers to Improve Hospital Price Transparency

by Jacqueline LaPointe

Federal and state governments are ramping up efforts to increase hospital price transparency as consumers become more responsible for their healthcare costs under high-deductible health plans. However, provider organizations are...

3 Strategies to Decrease Low-Value Care, Healthcare Costs

by Jacqueline LaPointe

Low-value care, or care for which the potential harm outweighs the possible benefits or there are little to no benefits, is unnecessarily driving up already high healthcare costs and putting providers at risk under value-based...

3 Strategies to Reduce Hospital Readmission Rates, Costs

by Jacqueline LaPointe

Providers understand that high hospital readmission rates spell trouble for patient outcomes. But excessive rates may also threaten a hospital's financial health, especially in a value-based reimbursement...

4 Key Ways to Improve Healthcare Revenue Cycle Management

by Jacqueline LaPointe

“There is always room for improvement” should be healthcare revenue cycle management’s mantra. Declining claims reimbursement rates, the shift to value-based purchasing, and evolving health policies keep revenue cycle...

4 Strategies for Merit-Based Incentive Payment System Success

by Jacqueline LaPointe

Medicare providers who qualify to participate in MACRA’s Merit-Based Incentive Payment System (MIPS) face up to a 4 percent incentive payment or penalty based on their performance in 2017. Despite MIPS putting revenue at risk, many...

Key Strategies for Health Systems to Achieve Economies of Scale

by Jacqueline LaPointe

Companies from across industries use economies of scale to realize cost savings. While hospitals and health systems are borrowing the economic concept to reduce spending, many healthcare organizations have encountered challenges with...

Top 4 Rural Hospital Challenges with Revenue Cycle Management

by Jacqueline LaPointe

Rural hospitals may be the only healthcare option for individuals living in sparsely populated areas, but revenue cycle management challenges have forced many of these facilities to permanently close their doors. The healthcare industry...

3 Challenges Providers Face with Healthcare Bundled Payments

by Jacqueline LaPointe

Healthcare bundled payments are becoming one of the most popular alternative payment models available to providers. Providers are drawn to the episode-based structure’s ability to decrease healthcare costs while maintaining or...

3 Best Practices for Hospital Claim Denials Management

by Jacqueline LaPointe

Healthcare cost control continued to top hospital priority lists in 2017. But hospital leaders may be leaving millions of dollars on the table because of inefficient claim denials management processes. Claim denial rates ranged between...

Top 4 Claims Denial Management Challenges Impacting Revenue

by Jacqueline LaPointe

For most healthcare organizations, claim denials are a normal, if not a frequent, occurrence. While very few can boast that their denial rates are close to zero, many providers face a number of challenges with implementing an effective...

4 Key Ways to Boost Point-of-Service Patient Collections

by Jacqueline LaPointe

In a time of healthcare consumerism and high-deductible health plans, the patient has become a major revenue source for healthcare organizations. But without strong point-of-service patient collection strategies, providers could be seeing...

3 Most Common Healthcare Supply Chain Management Challenges

by Jacqueline LaPointe

From gauze and paper gowns to implantable medical devices and prescription drugs, provider organizations must implement efficient healthcare supply chain management processes to cut overall costs and standardize care delivery. But for...

How to Improve Healthcare Mergers and Acquisitions Strategies

by Jacqueline LaPointe

Large and mid-size healthcare organizations should implement more proactive healthcare mergers and acquisitions strategies to avoid common acquisition mistakes, such as undefined growth strategies and deal overpayments, asserted Deloitte...

5 Ways to Increase Hospital Profitability, Aid Revenue Cycle

by Catherine Sampson

In this period of healthcare reform, numerous organizations continue to change their business practices so they can obtain more hospital profitability while also delivering quality care. Healthcare expenditures are expected to reach $4.4...

5 Ways to Improve Healthcare Supply Chain Management

by Catherine Sampson

In this age of payment reform, it’s vital for healthcare supply chain management to be effective if healthcare executives want to reduce costs and improve quality. An efficient supply chain has the ability to improve the delivery of...

5 Ways to Cut Costs through Hospital Revenue Cycle Management

by Catherine Sampson

As healthcare costs continue to rise, hospital revenue cycle management has become an important focal point for providers. Healthcare expenditures in the US are projected to reach $4.4 trillion by 2018, according to an article in The...

5 Most Common Hospital Revenue Cycle Management Challenges

by Catherine Sampson

Since the Affordable Care Act, the task of hospital revenue cycle management has changed significantly. Between ICD-10, MACRA, and accountable care, it has become a hospital’s best interest to have an effective revenue cycle...

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