4 Clinical Reasons for Denials
Denial prevention efforts should focus upstream in the revenue cycle, starting with patient status and continuing through documentation practices, coding, CDI, utilization review, and charge capture.
Calculating KPIs for Value-Based Payment Models
If hospitals and health systems know the patients for whom they’re at risk and the benchmarks against which they are held accountable, they can lower costs and improve outcomes for an entire population—not just a single patient.
Ask the Experts: Late Charge Reports
What is the general consensus on lab charges that are consistently late because of the need for specimen growth?
Using Seventh Characters
What are the key factors to consider when training coders on seventh characters?
Launching Revenue Integrity Programs in Hospital-Owned Practices
University of Maryland St. Joseph Medical Center’s revenue integrity program ensures a formal process to perform regular audits and educate physicians and their staff about compliance, and under-coding as well as over-coding.
HCC Coding: What Is It?
Hierarchical Condition Categories (HCCs) categorize diagnoses codes into groups with clinical and financial similarities and this payment method is coming on to the scene quickly.
Providence St. Joseph Advances Online Scheduling
The Providence St. Joseph Health system sees healthcare delivery through consumers’ eyes. “We are trying to learn when patients want to see us, what they are looking for, and what kind of friction do they encounter when they interact with us in the traditional way?” says Sunita Mishra of Express Care, the health system’s retail clinic arm.
Human Trafficking: Hidden Problem, Hidden Costs
New ICD-10 codes allow for clinicians to document treatment of human trafficking victims, but legal considerations should be taken before doing so.
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.
Offshore Coding Costs More in the Long Run
Offshore coder productivity was 34 percent lower per hour than domestic coders, according to a recent study. Healthcare organizations needed 51 percent more offshore coders, raising the effective hourly rate of offshore coders to $52.85 per hour, versus $60 for domestic coders.