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

Interviews

Addressing Quadruple Aim, Physician Burnout Key to Risk Success

November 16, 2017 - From capturing patient risk to meeting quality measures, providers face a daunting list of items needed to achieve the Triple Aim of value-based care. But healthcare organizations will not see lasting cost savings and care quality improvements until leaders address physician burnout and move to the Quadruple Aim, Reliant Medical Group’s President and CEO explained at the second annual...


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Automating Healthcare Contract Management Improves Business Ops

by Jacqueline Belliveau

Improving care access at hospitals is key to ensuring the health of pregnant women and their babies. But the business operations behind improving care access, such as employee and vendor contract management, must be as efficient as possible to...

The Pros and Cons of Quality Measure Choices In MACRA, MIPS

by Jacqueline Belliveau

Uprooting the fee-for-service payment system and changing the way clinicians provide care is no easy feat. With this in mind, CMS designed MACRA’s Merit-Based Incentive Payment System (MIPS) to gradually ramp up participation and offer...

Importance of Post-Acute Alignment, Integration to Value-Based Care

by Kyle Murphy, PhD

To achieve the ultimate goals of value-based care, healthcare organizations will need to assume greater responsibility over the patient’s experience across multiple care settings based on the appropriate level of acuity.   While the...

Full Risk Value-Based Care Key to Treating Vulnerable Patients

by Jacqueline Belliveau

Oak Street Health, a 24-primary care network headquartered in Chicago, aims to rebuild healthcare as it should be using value-based care contracts with full financial risk. The health system’s mission is to deliver personal, equitable,...

Health Centers Use Business Tactics to Compete with Private Orgs

by Jacqueline Belliveau

Federally qualified health centers (FQHCs) are the backbone of the healthcare safety net. But rising competition from hospitals and other healthcare organizations may be the straw that breaks that back. FHQCs receive enhanced Medicare and Medicaid...

Using EHR Systems, Supports to Aid MIPS Reporting, Boost Scores

by Jacqueline Belliveau

Delivering high-quality care is already a complicated process for healthcare providers. Understanding, as well as reporting, to MACRA’s Merit-Based Incentive Payment System (MIPS) has made the task even more complex, explained Brad J. Abrams,...

Provider Data Integrity Key to Directory Accuracy, Value-Based Care

by Jacqueline Belliveau

Providers and their payers oftentimes have a love-hate relationship. Payers boost the number of patients walking through physician office doors using provider directories as well as reimburse providers for treating those patients. But navigating...

Physician Advisors Crucial to Navigating Reimbursement Rules

by Jacqueline Belliveau

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, providers are finding that the business of...

CO’s Pediatric Care Network Brings Value-Based Care to Children

by Jacqueline Belliveau

Medicare has led the healthcare industry as it shifts from fee-for-service to value-based care, with 30 percent of traditional Medicare reimbursements already paid under an alternative payment model. The federal government plans to further transition...

MIPS Quality Reporting Flexibilities Trouble Providers, EHR Vendors

by Jacqueline Belliveau

It’s good to have options when it comes to the clothes we wear, cars we drive, and things we do. But having too many options when it comes to quality reporting under MACRA’s Merit-Based Incentive Payment System (MIPS) may prove to...

Bringing Back House Calls to Cut Spending on High-Risk Patients

by Jacqueline Belliveau

Before the early 1960s, the majority of healthcare visits were performed in patient homes. But as healthcare evolved, providers could no longer fit their tools in a transportable medical bag and the proportion of visits made by house calls dropped...

How Palomar Health Created a High-Value Post-Acute Care Network

by Jacqueline Belliveau

Ensuring patients receive high-value care delivery during their hospital stay or office visit is a top priority for healthcare providers. But value-based purchasing models are pressuring doctors to extend that same cost-efficient, high-quality...

Private Sector to Drive Bundled Payments After CMS Cancellations

by Jacqueline Belliveau

CMS recently announced its intention to modify its bundled payments strategy by proposing to eliminate forthcoming mandatory cardiac models and decreasing the scope of the Comprehensive Care for Joint Replacement (CJR) program. The pull away...

Real-Time Data for Denials Management Aids Practice’s Lagging A/R

by Jacqueline Belliveau

Without transparency throughout the claim denials management process, healthcare organizations are leaving a significant portion of potential revenue on the table. Limited access to timely claim denial and reimbursement data can prevent providers...

Physician Expert, Clinical Documentation Key to MIPS Success

by Jacqueline Belliveau

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). But regular updates and tweaks to MACRA have...

NYC Health’s ERP System to Bring Business Ops to Digital Age

by Jacqueline Belliveau

From payroll and workload management to orders and purchasing, health systems manage a myriad of back-end business operations, using a combination of automated systems as well as manual processes associated with each function. The web of disparate...

Accountable Care Organizations Grow, But Face New Challenges

by Jacqueline Belliveau

Since the Affordable Care Act paved the way for accountable care organizations (ACOs) in 2010, healthcare providers have increasingly turned to the alternative payment model as a way to engage in value-based care across patient populations. In...

Breaking Down the Top 5 Healthcare Revenue Cycle KPIs

by Jacqueline Belliveau

With value-based reimbursement and healthcare consumerism taking hold of the industry, provider organizations are under pressure to ensure their healthcare revenue cycle is operating at maximum efficiency. To effectively track healthcare revenue...

Geisinger Lowers Turnover for Healthcare Revenue Cycle Success

by Jacqueline Belliveau

A MAP Award for High Performance in Revenue Cycle from the Healthcare Financial Management Association (HFMA) indicates that a health system achieved outstanding healthcare revenue cycle performance on metrics such as net days in accounts receivable...

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