Revenue Cycle Management

A healthcare organization's revenue cycle is its financial circulatory system. Preventing denials of claims and maintaining a visible, efficient billing process are key parts of a healthy revenue cycle. However, very few organizations have a perfect revenue cycle process. "Without some critical changes to provider workflow and revenue cycle management practices, providers will, in coming years, spend even more time and money chasing patient receivables and dealing with increased levels of uncollectible patient responsibility dollars," says Ralph Bernstein, senior vice president of U.S. Bank Healthcare Payment Solutions.

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Slideshow: C-suite, business office differ on perceptions of revenue cycle vendors
Visibility key to efficient revenue cycle management

 
Commercial insurers inaccurately process about 20 percent of claims filed by medical practices. It's an industry standard that has weathered the test of time -- though not in a good way.
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Post date: October 22, 2014
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The offical transition to the ICD-10 coding set takes place next October (or so we hope). Many providers have already spent a good deal of money preparing for the inevitable, but even so, you need to make certain that select ICD-10 costs are included in your 2015 budget.
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Post date: October 22, 2014
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Significant inpatient pricing variation between hospitals in the state of Washington is "putting some consumers at financial risk," according to a recent study by the Washington Health Alliance. But the state's hospitals are questioning the report's conclusions, claiming that price variation should not be surprising.
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Post date: October 21, 2014
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Physician practices have the lowest revenue growth in the healthcare industry. When every dollar counts, anything from a lost referral to a bad online review can impact profitability. Here are some common revenue leaks and tips on plugging them.
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Post date: October 16, 2014
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While reducing reliance on expensive inpatient care is a sensible goal for hospitals, the transition away from a bricks-and-mortar, fee-for-service model is creating tremendous pressures on chief financial officers.
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Post date: October 16, 2014
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With an improving fiscal climate, some states are paying their Medicaid providers more. More states are increasing fees to specialists, nursing homes and managed care organizations, but 31 states were cutting or freezing Medicaid hospital rates, compared to 19 that were increasing them.
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Post date: October 14, 2014
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Most hospitals fall well short of their cost reduction targets, in part because the ability of chief financial officers to meaningfully impact how operational and clinical leaders approach the issue is limited.
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Post date: October 10, 2014
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New research suggests that socioeconomic factors can account for most of the geographical variation in Medicare spending. As a result, larger socio-demographic issues must be considered when assessing the quality of care offered by healthcare providers.
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Post date: September 25, 2014
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A program that combines a mobile app, analytics and direct intervention is showing promise in reducing the costs associated with hospitals' most expensive patients -- the so-called "super-utilizers."
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Post date: September 19, 2014
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The value-based model of healthcare is gradually transitioning from the pilot phase to implementation, as health insurers and providers strive to offer better care while eliminating unnecessary costs. But for providers who have always been paid fee-for-service, it is a different way of thinking.
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Post date: September 17, 2014
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Predictive analytics uses a variety of statistical techniques that analyze current and historical facts in order to make predictions about the future. In the healthcare setting, such data analysis can be effective in addressing a variety of key issues, including preventable readmissions.
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Post date: September 16, 2014
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Weill Cornell Physicians, Cornell University's physician group, has inked a new accountable care agreement with Aetna, intended to enhance care for approximately 9,000 of the insurer's commercial and Medicare members in New York.
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Post date: September 11, 2014
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Though over 30 states have passed or proposed legislation to increase healthcare price transparency, and released median prices for specific services, many supporters of price transparency have pushed for more detailed data.
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Post date: October 23, 2014
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Improving the health of at-risk, vulnerable and chronically sick populations remains a massive challenge for healthcare organizations' financial administrators. In order to properly manage complex populations, comprehensive and reliable data on patient health and demographics are required.
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Post date: October 22, 2014
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More than ever before, physicians and managers are feeling the stress of running a practice. Though most medical schools do not teach business principles to physicians in residency, it is just as important to invest in education about the business side of medical practice as in the clinical aspects.
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Post date: October 17, 2014
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Like many other industries, healthcare is looking to leverage information technology to transform financial payments and automate the posting of accounts payable and accounts receivable processing systems. But which method to choose?
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Post date: October 15, 2014
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Healthcare providers are realizing they must create and sustain a more effective revenue cycle to ensure long-term viability. To remain competitive, providers must closely evaluate the current state of their revenue cycle and implement improvement opportunities.
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Post date: October 14, 2014
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The 2015 Medicare Part A deductible -- for inpatient hospital, skilled nursing facility and home healthcare services -- will increase by $44 in calendar year 2015 to $1,260, while the monthly Part A premium will decline by $19. Medicare Part B monthly premiums and deductibles will remain unchanged.
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Post date: October 13, 2014
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The Centers for Medicare & Medicaid Services has published a final rule updating the hospice wage index and payment rate for Fiscal Year 2015. It adopts a number of payment reforms addressing concerns about program integrity, beneficiary protection and quality.
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Post date: September 22, 2014
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In its new rules, CMS places great emphasis on the physician's documentation regarding his or her expectation of a patient's need for hospital care and anticipated length of stay. Therefore, it is essential that all hospital physicians are educated about the heightened importance of documentation within the medical record.
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Post date: September 15, 2014
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In its new rules, CMS places great emphasis on the physician's documentation regarding his or her expectation of a patient's need for hospital care and anticipated length of stay. Therefore, it is essential that all hospital physicians are educated about the heightened importance of documentation within the medical record.
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Post date: September 15, 2014
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According to the KISS principle, most systems work best if they're kept simple. Simplicity is the key goal in design, and unnecessary complexity should be avoided. Clinical documentation improvement and ICD-10 preparation are no exception.
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Post date: September 10, 2014
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Inpatient rehabilitation services are already a big target area for recovery audit contractors, and there will likely be more denials as audits ramp back up. Providers must remain consistent, proactive and vigilant to protect their revenue.
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Post date: September 8, 2014
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Working together, CFOs and CIOs can breathe new life into their growth strategy by thinking beyond architectural and functional limits of their EHRs. They must embrace new ideas and technologies that will introduce market advantages and the financial elixir of much-needed share gains.
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Post date: September 4, 2014
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