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


Healthcare RCM, Medicare Reimbursement Dominate 2017 Stories

December 14, 2017 - From the Quality Payment Program’s launch to the Affordable Care Act debate, the healthcare finance world saw an abundance of change and uncertainty in 2017. In the face of payment reform and political debates, healthcare leaders focused on ensuring their organizations built a strong healthcare revenue cycle management foundation that could withstand any possible changes. The...

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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 pr...

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 achiev...Once a health system decides on the scale model, the organization can use four methods for implementation. First, health systems can engage in inorganic scale, which encompasses healthcare merger and acquisition activities. Second, health s...Health systems should assess the potential risk and benefits of each scale model and implementation method, researchers recommended. Encourage facilities to work as one rather than independently While not all economies of scale strategies i...Health systems should also restructure roles and decision rights to implement the operating model. For example, corporate core entities should define organizational goals, rationalize the portfolio, set performance targets, and approve inve...Similarly, health systems may determine that one hospital in its system should not deliver specific services because they are not profitable to furnish in that setting. Mercy experienced this situation when the system entered into a managem...

Top 10 Enterprise Resource Planning (ERP) Vendors By Hospital Use

by Jacqueline LaPointe

Healthcare providers have become increasingly interested in implementing enterprise resource planning (ERP) systems as part of their business intelligence and revenue cycle management suites. ERP systems are business management tools that g...

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 has...While hospitals across the nation are feeling the impact of a shrinking workforce, rural areas have been especially troubled by the lack of providers practicing. Former CMS Administrator Andy Slavitt told attendees at the 2016 CMS Rural Hea...As a result, rural hospitals tend to experience higher healthcare costs and worse patient outcomes because of their high-risk patient population. Rural hospitals can alleviate some of the cost burden associated with treating uninsured indiv...Despite the financial assistance, some rural hospital support from CMS is set to expire in 2017. The AHA recently urged policymakers to back the Rural Hospital Access Act of 2017 that would continue the Medicare-Dependent Hospital Program. ...

Breaking Down the Top 5 Healthcare Revenue Cycle KPIs

by Jacqueline LaPointe

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 re...The former healthcare consultant and community hospital CFO recently explained to that starting with top KPIs and expanding to other metrics should provide hospital and practice leaders with a strategic view of how ...The information needed to calculate net days in A/R stems from an organization’s balance sheet and income statement. The industry group clarified that net A/R is the net patient receivable on the balance sheet and it comprises the net...Providers organizations should not include non-patient A/R, 340B Drug Purchasing Program revenue, capitation or premium revenue from value-based contracts, and A/R related to non-patient-specific third-party settlements (eg, payments from M...The total collected service cash is the monthly revenue from patient service payments posted to patient accounts, including undistributed payments, bad debt recoveries, Medicare DSH reimbursement, and IME payments. The value is net refunds,...For the number of claims denied, organizations should find the total number of processed claims in a month and identify the actionable denials, or denials that could be corrected within the organization to boost reimbursement. This includes...HFMA elaborated that the value for net dollars written off as denials in a month includes denied RAC revenue from failed appeals or neglecting to appeal as well as dollars stated at net. The average monthly net patient service revenue ...Finding operational performance with a cost to collect KPI To find healthcare revenue cycle efficiency and productivity, provider organizations should create a cost to collect KPI. Leaders can find the rate by dividing the total revenue cyc...“The following revenue cycle costs should be reported with their respective functional area’s costs as applicable: salaries and fringe benefits, subscription fees, outsourced arrangements, purchased services, software maintenanc...

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 improvi...Researchers also advised provider organizations to consider partnering with post-acute care facilities, rather than acquiring them. Partnerships tend to be more affordable and faster to implement. By partnering with the facilities, organiza...

21 States Have Overbilled the FFS Medicare Program

by Vera Gruessner

New research from the Centers for Medicare & Medicaid Services (CMS) shows that 21 states have above average rates of overbilling the Medicare program. The Supplementary Appendices for the Medicare Fee-for-Service (FFS) Improper Payment...

4 Healthcare Supply Chain Management Tips for Revenue Success

by Jennifer Bresnick

In a healthcare organization, keeping tabs on the ebb and flow of medical supplies is an incredibly important yet often overlooked task.  From syringes and gauze to drugs, disinfectant, and paper gowns, understanding supply chain manag...

3 Key Steps to Continue ICD-10 Implementation Progress

by Vera Gruessner

Now that the ICD-10 implementation has been deemed a relative success throughout the healthcare industry, the Centers for Medicare & Medicaid Services (CMS) are focused on continuing the progress related to the ICD-10 implementation. CM...

5 Ways Smaller Providers Maximize Revenue Cycle Management

by Jacqueline DiChiara

Revenue cycle management is about breaking through the cash flow ceiling and generating the greatest amount of net revenue possible. But issues of claims denials, coding compliance, where to intelligently cut cost corners, automation h...

5 Supply Chain Management Questions and Answers

by Jacqueline DiChiara

A chain is no stronger than its weakest link. But strengthening the most fragile links when many moving parts collectively bump into each other along the way is no easy task when it comes to supply chain management. Here are 5 supply chain ...

4 Noteworthy Point-of-Service Strategies We Learned in 2015

by Jacqueline DiChiara

Just as Ebenezer Scrooge from Dickens’ A Christmas Carol has money on his mind, so does the healthcare industry. The importance of collecting money from a patient at or before point-of-service was a significant revenue cycle focus thi...


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