Revenue Cycle Management

Auditors Recouped $214M in Medicare Improper Payments in 2016

by Jacqueline LaPointe

Recovery Audit Contractors (RACs) returned significantly more Medicare improper payments to the program’s trust fund during the 2016 fiscal year (FY), a recent CMS report to Congress shows. In...

Medicare Advantage Plans Overturn 75% of Their Own Claim Denials

by Jacqueline LaPointe

A new report from the HHS Office of the Inspector General (OIG) reveals “widespread and persistent problems” related to prior authorization and claim denials in Medicare Advantage. Using...

Clinical Documentation Improvement Solutions Up Provider Revenue

by Jacqueline LaPointe

Provider organizations are seeing financial improvements after implementing clinical documentation improvement (CDI) solutions, a recent KLAS survey shows. Revenue improved for about 53 percent of...

AMA, AHIP, and Others Oppose Upside-Only ACO Changes for MSSP

by Jacqueline LaPointe

The American Medical Association (AMA), Medical Group Management Association (MGMA), and Health Care Transformation Task Force (HCTTF) are among nine industry groups calling on CMS to reconsider...

End-to-End Revenue Cycle Management Key to Success at Ascension

by Jacqueline LaPointe

The healthcare revenue cycle contains many moving parts. Hospitals and health systems typically rely on a patchwork of technologies and best practices to ensure everything from patient access and...

MSSP ACOs Saved $1.84B, Nearly Double CMS Estimate, Study Finds

by Jacqueline LaPointe

CMS estimates that accountable care organizations (ACOs) in the Medicare Shared Savings Program (MSSP) saved $954 million from 2013 to 2015. However, a new Dobson DaVanzo & Associates analysis,...

RCCH Uses Predictive Analytics to Boost Claim Denials Management

by Jacqueline LaPointe

Predictive analytics are key to implementing an effective and efficient claim denials management strategy that tackles the right denials at the right time, according to the Vice President of Revenue...

How Next Generation ACOs Built a Foundation for Success

by Jacqueline LaPointe

Employing additional administrative staff, prioritizing care management, and building data analytics capacity were key strategies accountable care organizations (ACOs) implemented to participate in the...

Hospital Financial Performance Lags with Revenue Cycle Outsourcing

by Jacqueline LaPointe

Revenue cycle outsourcing may not be the financial answer hospitals are looking for, according to a recent analysis from the public accounting, consulting, and technology firm Crowe. The analysis of...

Artificial Intelligence Ensures Payer, Provider Pay Covers Costs

by Jacqueline LaPointe

Artificial intelligence (AI) in healthcare is influencing the next generation of radiology tools and helping to expand access to care in underserved or developing areas. The technology is supporting...

Docs Could Avoid 34% of Out-of-Network Patient Referrals with Data

by Jacqueline LaPointe

Providers recognize the importance of making in-network referrals for care coordination and patient retention. However, 79 percent of physicians still refer patients to other providers outside their...

Shift Admin, QGenda Top Physician Scheduling Vendors, KLAS Reports

by Jacqueline LaPointe

Shift Admin and QGenda are the physician scheduling vendors giving provider organizations their money’s worth for the time saved using the solution, KLAS recently reported. In a series of...

CFOs Expect Higher Hospital Labor Costs As Staffing Shortages Loom

by Jacqueline LaPointe

About 78 percent of healthcare finance leaders expect hospital labor costs to grow in the next 12 months as the industry faces a worsening shortage of healthcare professionals, a new survey shows. The...

Using Text Messages to Improve Healthcare Recruitment, Employment

by Jacqueline LaPointe

Getting qualified healthcare professionals in the door for interviews as quickly as possible is paramount for provider organizations facing a competitive healthcare recruitment and employment...

Next Generation ACOs Save Medicare $62M, Maintain Care Quality

by Jacqueline LaPointe

Accountable care organizations (ACOs) in the Next Generation ACO program produced nearly $62 million in net savings to Medicare while maintaining care quality in 2016, CMS recently reported in the...

Group Purchasing Saves Hospitals Up to 18% of Supply Chain Costs

by Jacqueline LaPointe

Group purchasing organizations (GPOs) are saving hospitals and other healthcare facilities between 10 to 18 percent, a new report revealed. The Healthcare Supply Chain Association’s (HSCA)...

HHS to Clear Medicare Appeals Backlog by 2022, Court Docs Show

by Jacqueline LaPointe

HHS is making significant progress with eliminating the growing Medicare appeals backlog, according to recent court documents. The federal department projects Medicare to clear the backlog by the 2022...