Category: Revenue Cycle Management

Impacts of Claim Denials on Revenue Cycle

How Claim Denials and Payer Audits Impacts Healthcare Revenue Cycle

Denial rates, notably within Medicare Advantage, are on the rise, impacting both hospital revenue cycles and patient care, remarked the executive director of a Minnesota-based large multispecialty health care organization focused on Revenue Cycle management. Despite the organization reporting a favorable margin this year, it falls short in achieving profits comparable to those of insurers, […]
Learn More
Denial Management in RCM

Navigating Denial Management Challenges in Revenue Cycle Management

Denial management in rcm: In the intricate realm of healthcare revenue cycle management (RCM), the substantial challenge revolves around handling denied claims. Scarcity of resources, understaffing, and restricted capacity frequently lead to difficulties in resolving denied claims, where an alarming 82% to 90% are considered potentially preventable. RCM teams can optimize time and revenue recovery […]
Learn More
Steps-to-reduce-claim-denials

Effective Revenue Cycle Management Strategies to Reduce Denials & Boost Revenue

Healthcare organizations consistently grapple with the complexity of overseeing their revenue cycles—a comprehensive process spanning patient registration, appointment scheduling, and concluding with balance payments. Yet, a pivotal hurdle disrupting this cycle’s seamless operation is the prevalent occurrence of claim denials. Vital for any healthcare institution’s financial well-being is the imperative to diminish these denials and […]
Learn More
Value-Based-Care-Plans-improved-health-outcomes-for-MA-members

Medicare Advantage Value-Based Care: Enhanced Health Outcomes

Alongside its positive impact on health outcomes, the Medicare Advantage value-based care plans implemented by an insurance provider resulted in a significant $8 billion in cost savings throughout 2022. Reports from the payer revealed that Medicare Advantage beneficiaries under value-based care exhibited improved health conditions, marked by reduced inpatient admissions and emergency room visits. The […]
Learn More
High-time-to-ponder-over-a-new-Outsourcing-Model-in-Healthcare

The Rise of Hybrid Global Outsourcing Models in Healthcare

Given labor shortages and financial constraints, fully managed hybrid outsourcing solutions are increasingly gaining prominence. Hospitals and provider organizations grapple with staffing deficiencies across various departments, with the revenue cycle facing considerable strain. A recent survey among medical group leaders highlighted coders as the most challenging role to fill, closely followed by billers, schedulers, authorization […]
Learn More
Benefits-of-ABNs-for-Providers-and-Medicare-beneficiaries

Understanding ABNs for Providers and Medicare Beneficiaries

The Advance Beneficiary Notice (ABN), Form CMS-R-131, issued by the Centers for Medicare & Medicaid Services (CMS), holds immense importance for healthcare providers, revenue cycle teams, and Medicare beneficiaries. What is an ABN (Advance Beneficiary Notice)? An ABN, formally extended to Medicare Fee-for-Service (FFS) beneficiaries, precedes outpatient services like labs, imaging, physical therapy, or observation. […]
Learn More
Top-5-Healthcare-Revenue-Cycle-key-performance-indicator

Unveiling the Top 5 Healthcare Revenue Cycle KPIs

Key Performance Indicators (KPIs) within the healthcare revenue cycle play a vital role in monitoring financial well-being and optimizing revenue capture for providers. Understanding these metrics is crucial for healthcare organizations aiming to sustain access to high-quality, cost-effective care—an essential aspect of the evolving landscape of value-based care and healthcare consumerism. These KPIs offer critical […]
Learn More
3.4%-CUT-in-Medicare-Physician

2024 Medicare Physician Fee Schedule: Changes, Impact, and Updates

The 2024 Medicare Physician Fee Schedule, recently released by CMS, confirms the anticipated reduction in payments for physicians. The finalized conversion factor of $32.7442 represents a 3.4% decrease from the 2023 rates, which themselves saw a 2% reduction from 2022. In contrast, the Medicare Economic Index, a gauge of practice cost inflation, surged to 4.6%, […]
Learn More
CMS-Final-Rule's-Reduction-on-physician-reimbursement

CMS Final Rule 2023: Impact on Physician Reimbursement and Healthcare Facilities

Despite the American Medical Association’s (AMA) strong protests regarding a 26 percent decrease in physician reimbursement from 2001 to 2023, it seems that these objections have not been heeded. On November 2, the Centers for Medicare & Medicaid Services (CMS) announced their final policy changes, which include significant reductions in reimbursement for the upcoming year. […]
Learn More
x