Focus On RCM Compliance

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Out-of-Network Billing for Hospital Care Boosts Spending by $40B

by Jacqueline LaPointe

Patients receiving care at in-network hospitals face a significant risk of out-of-network billing for services performed by hospital-based anesthesiologists, pathologists, radiologists, and assistant...

Federal Hospital Reimbursement to Take $252B Hit by 2029

by Samantha McGrail

Twelve legislative acts, as well as regulatory changes from CMS, are estimated to reduce federal hospital reimbursement by $252.6 billion by 2029, a new report from the health economics consulting firm...

Exploring Hospital Chargemaster Management Best Practices

by Jacqueline LaPointe

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...

MedPAC Suggests Elimination of Incident To Billing for APRNs, PAs

by Jacqueline LaPointe

CMS should do away with “incident to” billing for advanced practice registered nurses (APRNs) and physician assistants (PAs) and pursue a stay-based payment design when implementing a...

40% of Revenue Cycle Leaders Don’t Discuss Charge Capture Regularly

by Jacqueline LaPointe

Over three-quarters (78 percent) of revenue cycle leaders at acute care organizations agreed charge capture is essential to an organization’s success, yet most leadership teams only discuss...

CMS Boosting Audits to Combat Medicaid Fraud, Improper Payments

by Jacqueline LaPointe

In efforts to prevent Medicaid fraud and improper payments, CMS plans to increase the number of audits in the public healthcare program and optimize state-provided claims and provider data, according...

Maximizing Provider Revenue with Payer Contract Management

by Jacqueline LaPointe

Ensuring correct reimbursement in a timely manner is always at the top of a healthcare provider’s mind. But many provider organizations could be leaving money on the table with inefficient and infrequent payer contract...

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...

Hospital Utilization Management Can Reduce Denials, Improve Care

by Jacqueline LaPointe

Utilization management in healthcare is commonly thought of as a strategy that payers employ to control resource use within physician offices and hospitals to keep healthcare costs down. However, hospital utilization management programs...

Hospitals, Systems Spend $39B Annually on Regulatory Compliance

by Jacqueline LaPointe

Hospitals, health systems, and post-acute care providers spend almost $39 billion annually on administrative tasks related to regulatory compliance, the American Hospital Association (AHA)...

Physician Advisors Crucial to Navigating Reimbursement Rules

by Jacqueline LaPointe

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,...

Physician Expert, Clinical Documentation Key to MIPS Success

by Jacqueline LaPointe

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)....