Helping patients understand their financial responsibility and pay for services continues to be driven by an outdated and unnecessarily complex experience. Last year, three in 10 Americans had an unpaid healthcare bill go to collections. As more of the financial burden falls to patients with rising costs and an increase in high-deductible health plans, consumers are frustrated […]
HIV/AIDS payments, in particular, are under the microscope. The new Patient-Driven Payment Model, or PDPM, makes radical changes to the Medicare payment model for nursing homes. One of the largest changes is the reimbursement rate for services provided to HIV and AIDS patients. In 2016, there were 15,807 deaths among people with diagnosed HIV in […]
Providers are encouraged to file protective appeals. “In section XI of the preamble of the proposed rule, we discussed the growing number of Provider Reimbursement Review Board (PRRB) appeals made by providers and the action initiatives that are being implemented with the goal to decrease the number of appeals submitted; decrease the number of appeals […]
Several changes to the Merit-based Incentive Payment System (MIPS) track of the Quality Payment System (QPP) are outlined in a proposed rule for 2020 revisions to payment policies under the Physician Fee Schedule (PFS). Most of the proposed changes come as no surprise, but there is one proposal, in particular, that will make a huge impact on […]
Revenue cycle management technology is at the heart of the administrative side of business at every hospital and health system. It is key to daily operations. As such, healthcare CIOs and other IT professionals must take great care when implementing RCM systems. Getting revenue cycle done right – and done right the first time – […]
On Aug. 15, 1935, Will Rogers died in a plane crash near Point Barrow, Alaska. He is an Oklahoma legend and one of the best political satirists and commentators ever. I often wonder what his commentary would be on the state of U.S. politics in 2019. As an aside, Oklahoma City has two airports named […]
In the crowded healthcare market, smart healthcare leaders must find patient satisfaction advantages everywhere they can. When it comes to patient satisfaction, providing excellent clinical care is a no-brainer. But in a crowded and competitive healthcare market, smart healthcare leaders know that they need an edge everywhere, including an efficient revenue cycle. That’s the case […]
Final rules will impact nearly every type of healthcare provider. The Centers for Medicare & Medicaid Services (CMS) presented us with quite a number of Medicare payment rules in the last week or so, referencing almost every type of provider in the program. The final rules included the Fiscal Year (FY) 2020 Medicare Hospital Inpatient […]
Medical necessity denials continue to be a pain point for revenue cycle leaders, so much so that HBI members reported medical necessity as one of the top three root causes in 2016, 2017, and 2018. While denials and appeals are typically housed within the revenue cycle, there are many other teams—including clinical staff, utilization review, […]
Data was big in revenue cycle challenges long before “Big Data” was a buzzword. The same goes for the challenges that come with it. For years, revenue cycle challenges for leaders have looked for answers to common hurdles like missing or incorrect charges, payment file problems, and data transfer timing delays. Big Data and advanced […]