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

Interviews

A Provider-Sponsored Health Plan Is A Hospital’s Natural Next Step

July 16, 2018 - 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 Health Plan’s Chief Financial Officer. “It’s important to think about how important hospitals are to local communities. In many health systems,...


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Providers Investing in Home Health to Prepare for Aging Population

by Jacqueline LaPointe

Faced with the pressure to reduce healthcare costs as the elderly population rapidly grows, providers plan to shift elder care from hospitals and skilled nursing facilities to the home, healthcare experts explained. According to CMS and Census...

Quality Improvement Projects Save Children’s Hospitals Millions

by Jacqueline LaPointe

Care quality improvements require hospitals to invest their money, time, and staff. The investment may be large, but for two children’s hospitals it paid off, saving the organizations millions and reducing costly accidents and unnecessary...

Healthcare Mergers, Increased Access to Boost Medical Costs 6%

by Jacqueline LaPointe

PwC’s Health Research Institute (HRI) predicts medical costs for employers to grow 6 percent in 2019 as healthcare mergers and more convenient care access options drive up healthcare costs and utilization. The medical cost trend is consistent...

Automated Physician Queries Improve Clinical Documentation at WMHS

by Jacqueline LaPointe

Accurate claims reimbursement hinges on complete clinical documentation, and therefore, quick responses to physician queries regarding medical record documentation and coding. This is especially true in Maryland’s unique hospital reimbursement...

Giving GA Hospitals Healthcare Cost Data to Lowering Spending

by Jacqueline LaPointe

With claims reimbursement rates falling and competition among healthcare organizations intensifying, hospitals are calling on their providers to increase efficiency and reduce healthcare costs for each admission. So, what do providers need to...

Payment Plans Key to Collecting Patient Financial Responsibility

by Jacqueline LaPointe

With the rise in popularity of high deductible health plans, hospitals are no longer waiting on just payers to collect what is owed to their hospital or practice. Patients have become a major revenue source, but hospitals are struggling to implement...

Addressing Productivity, Labor to Bend the Healthcare Cost Curve

by Jacqueline LaPointe

From alternative payment models and value-based purchasing to artificial intelligence and data analytics tools, the healthcare industry is transforming how care is delivered and paid for to reduce constantly rising medical costs. While payment...

“Just the Beginning” of Healthcare Price Transparency, Verma Says

by Jacqueline LaPointe

Requiring hospitals to post a list of their standard charges online is just the beginning of the push for increased healthcare price transparency by CMS, explained the federal agency’s Administrator Seema Verma. “As people are paying...

Gaining Visibility into Healthcare Workforce Management Cuts Costs

by Jacqueline LaPointe

If it takes a village to raise a child, then it may take an entire city to operate a health system. From executives and clinicians to IT managers and front desk staff, healthcare workforce management involves hundreds to thousands of employees...

RFID, Smart Cabinets Improve Hospital Supply Chain Management

by Jacqueline LaPointe

From EHR systems and revenue cycle management tools to data analytics and online patient payment options, hospitals and health systems are on the journey to automating all aspects of the healthcare experience. However, the hospital supply chain...

Real-Time Insights into Nursing Workflow Maximizes Productivity

by Jacqueline LaPointe

An elderly patient presses the nurse call button to get assistance with standing up and using the toilet, while another patient in the next room presses the button to get help with changing the TV channel. Further down the hall, lights turn on...

OR Efficiency, Machine Learning Boosts UCHealth’s Revenue by $10M

by Jacqueline LaPointe

Moving from traditional block scheduling for the operating room (OR) to more of a service-based system that used machine learning maximized OR efficiency and increased revenue by $10 million across UCHealth’s University of Colorado Hospital...

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 claim rates. While professional codes primarily...

Transforming the Hospital Laboratory into a Profit Center

by Jacqueline LaPointe

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 Operations...

A Holistic View of the Patient Enables Risk-Based ACO Success

by Jacqueline LaPointe

Giving providers a holistic view of the patient resulted in accountable care organization (ACO) success for a risk-based organization in southern Florida, which earned a place on the list of ACOs achieving the greatest shared savings in the Medicare...

Slow and Steady Still the Motto for Value-Based Reimbursement

by Jacqueline LaPointe

The healthcare industry has boarded the train to value-based reimbursement. But recent roadblocks have provider organizations pumping the brakes with the shift away from fee-for-service, explained industry experts Doral Jacobsen, MBA, FACMPE,...

Patient Education Boosts Revenue, Quality for Joint Replacements

by Jacqueline LaPointe

Offering interactive patient education pre- and post-total joint replacement surgery is key to improving patient outcomes and generating new revenue, a multi-specialty hospital system in the Twin Cities area recently found. An estimated 7 million...

Prehabilitation Lowers Episode Costs Under Bundled Payment Models

by Jacqueline LaPointe

Dedicating even a couple hours to helping patients understand and prepare for a procedure prior to surgery can save providers millions under bundled payment models, explained healthcare industry expert and former CMS official Charlene Frizzera....

Reducing Low-Value Care Key to Value-Based Reimbursement Success

by Jacqueline LaPointe

Value-based reimbursement success hinges on decreasing low-value care across patient populations, explained Scott Weingarten, MD, MPH, Senior Vice President and Chief Clinical Transformation Officer at Cedars-Sinai Medical Center. While hospitals...

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