Denials Management

hfm Magazine: September 2018

August 31, 2018 12:03 pm

Cover Story

Revenue Cycle Outsourcing Requires Attention to Service Standards and Risk-Based Arrangements 
When a healthcare provider chooses to outsource management of its revenue cycle, it should first make sure the arrangement with its vendor partner is well-designed, with clearly defined terms and financial incentives.
By David A. Wofford, MBA, and John C. Whitham, MHA

Web Exclusives

New Approaches for Improving the Cost of Care   
Data provided by internal and external sources can give healthcare providers valuable insight into areas for cost improvement.  
By Theresa Hush  

Ensuring the Revenue Cycle Gets a Clean Bill Of Health 
Health systems can reduce denials by using claims management tools, but their use must be supported by a commitment to ongoing process improvement within the organization.
By Eric Matson   

Justifying Expansion of CDI Programs: A Case Study
On hospital’s experience in broadening the focus of its clinical document improvement (CDI) program from just Medicare to all payers shows how healthcare providers can benefit financially from such a change. 
By Autumn Reiter, BSN, RN, CCDS, CDIP, CCS, and Lori A. Dixon, MSN, RN-BC, CDIP

Repurposing TDABC: Case Examples from a New York Hospital
Time-driven activity-based costing principles provide an excellent basis for helping healthcare organizations identify opportunities for improving their operations.
By Sourjya Patnaik and Lillian Diaz 



4 Steps for Success in a Changing Payment Landscape 
The experiences of oncology practices participating in CMMI’s Oncology Care Model offer insight on how physician practices can best adapt their revenue cycle for value-based payment models. 
By Charles Saunders, MD

Success in Proactive Denials Management and Prevention 
Adopting a few key best practices can help healthcare organizations reduce denials. 
By Glen Reiner

Technology and a Strong Patient Focus Help Providers Excel in Revenue Cycle Performance
Winners of HFMA’s MAP Award for High Performance in Revenue Cycle offer lessons learned for revenue cycle excellence.
By Laura Ramos Hegwer


Focus Area

Integrated Revenue Cycle: Coordination Between Insurers and Providers to Ensure Revenue Accuracy 
Working together, insurers and providers can realize mutual benefits of verifying the accuracy of information. 
By Brandon Solomon and Brad Helfand


From the Chair
Imagining the Healthcare Revenue Cycle of Tomorrow
The healthcare Financial Management Association (HFMA) will be source for all things required to create the healthcare revenue cycle of tomorrow.  
By Kevin Brennan, FHFMA, CPA

On Point     
Protecting Against Cybersecurity Threats 
With the increasing sophistication of cyberattacks in health care, hospitals and health systems must make sure they have effective cybersecurity infrastructures to protect themselves and their patients from such attacks.
By David Lee, JD, and Jenna Jackson

Eye On Washington  
Administration Meets Challenge to Risk-Adjustment Payments, Counter to Critics’ Assumptions 
Responding to a New Mexico district court’s ruling against the risk-adjustment program established by the Affordable Care Act, CMS initially put the program’s payments to collections and payment on hold, but then took steps to reinstate the program.
By Gail R. Wilensky, PhD

Business Intelligence            
Pivoting Revenue Cycle Efforts to Resolve New Financial Realities
Shifts in payment trends require healthcare organizations to work more effectively with insurers and patients.         
By Theresa Hush

Healthcare Innovation  
Balancing Innovation and Delivery
As healthcare organizations look toward moving into the next phase of innovation, they must not lose sight of their core mission. 
By Brandon Klar

From the President 
The Future of Consumerism
HFMA President and CEO Joe Fifer discusses rising consumer expectations in health care and what it will take to meet them.
By Joseph J. Fifer, FHFMA, CPA


Data Trends 
5 DRGs Are Primary Contributors to Rising Average Loss per Medicare Hospital Admission
Among Medicare admissions in 2015 to 2017, costs per admission rose more rapidly than did payments, and the impact of this trend on hospitals’ financials strongest with admissions associated with 5 DRGs. 


Executive Roundtable     
Key Considerations for Revenue Cycle Outsourcing     
A roundtable discussion about the advantages of revenue cycle outsourcing and important considerations for decision making.
Sponsored by Optum

Executive Roundtable  
Revenue Integrity in the Pharmacy
Roundtable discussion about the importance of preserving pharmacy revenue integrity and strategies for success.
Sponsored by Craneware


Business Profile    
HealthTrust: Solving Workforce Management Challenges 
Two of HealthTrust’s senior leaders talk about strategies for optimizing the hospital workforce to improve productivity and reduce waste. 


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