Tag: Revenue Cycle Management

Medicare Advantage Plans and the Two-Midnight Rule

Controversy continues to swirl around this subject. A recent article of mine focused on the argument that Medicare Advantage (MA) plans have to follow the two-midnight rule. It certainly generated buzz; I received a number of emails with comments and questions. First, I want to note that I love getting comments and questions. I can’t […]
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“Defensive” Undercoding Is Indefensible

  Undercoding, or reporting a lesser service than was performed and documented, is sometimes employed as a defensive strategy to stave off claims denials or audits. But, undercoding can make a provider an outlier, and may create consequential patient care, compliance, and financial liabilities. For example: Undercoding Leaves Money On The Table, Driving Down Provider […]
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3 Key Strategies to Increase Healthcare Revenue Cycle Efficiency

  As providers engage in complex payment models and collect more from patients, they must learn to automate key functions to improve healthcare revenue efficiency. The healthcare revenue cycle has many moving parts. From patient access and registration to medical billing and coding, provider organizations of all sizes must achieve revenue cycle efficiency to ensure […]
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Preparing Providers For Value-Based Care, Consumerism In Healthcare

Technology can transform data into actionable insights for providers needing to meet the demands of value-based care and consumerism in healthcare. Transforming raw data into actionable information is crucial to the financial future of provider organizations, especially as pressure builds on providers to align their care delivery approach with value-based care and consumerism in healthcare. […]
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Federal Policy to End Surprise Billing: Building on Prior Approaches

Ending surprise medical bills has risen to a national priority with bipartisan political interest. In January, President Donald Trump directed Cabinet officials to find a solution, and multiple congressional bills were proposed in the last Congress with the same goal. Surprise medical bills consist of unanticipated charges from out-of-network clinicians—often when the facility or primary physician is […]
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Coding “Separate Procedures:” What Coders Need to Know

  “Separate procedure” may not mean what you think. Many procedural codes in the CPT® Book are designated as “separate procedures.” However, the common misinterpretation of this is that coders can report such codes as such in every case. Not true. First, you must consider: Were there other procedures performed during the same encounter? Did you […]
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To Increase Patient Satisfaction, Providers Need to Start Talking About Costs: Survey

Even as health systems confront rising healthcare costs and declining margins, they are under pressure to improve the patient experience, retain customer loyalty and collect patient payments. But while two-thirds of patients said cost strongly influences their overall satisfaction with their hospital or physician, nearly 60% of health systems do not discuss costs with patients, […]
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MACRA Readiness for Healthcare Organizations

Without even putting too much effort into listening to or reading the news, you understand that healthcare costs have steadily risen over the last couple decades, and yet we don’t really have any significant and correlating rise in outcomes to show for it.  CMS or the Centers for Medicare and Medicaid Services has also noticed […]
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Chronic Conditions: Code or Not to Code MCCs

  Understanding the correct use of chronic condition codes in the coding process. Unexpected and inaccurate medical bills can be alarming and shocking. Coders are often confused regarding when they should code co-morbid chronic conditions and when they should not. This leads to inaccurate coding of levels, or sometimes missing out on the opportunity of […]
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Why Hospitals Without Robust Revenue Cycle Support are Losing Millions?

A frequent knock on electronic health records (EHRs) has been that they’re just glorified billing systems that fail to provide enough clinical functionality to make a significant difference in the quality of care. So it’s somewhat incongruous that a recent Black Book report on revenue cycle management (RCM) system adoption would say that 26 percent of hospitals don’t have an effective […]
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