The vital relationship between MDs and clinical documentation integrity
High-quality clinical documentation is vital for creating a complete picture of a patient’s health and medical history. Accurate records of diagnoses, medications, tests, treatments and other elements of a patient’s care are crucial in creating the most effective care plan leading to positive outcomes. The quality of a physician’s clinical documentation can also impact payer…
Personalized communication helps State provide the highest possible recovery and patient-satisfaction rates for clients
Learn about a company that combines advanced technology with human interaction to increase recoveries and patient satisfaction.
How one health system focused on revenue cycle staff education to improve its denial rate
Many longtime revenue cycle leaders can recall a simpler time when insurance companies sold plans that were broadly accepted by providers in their service areas. Back then, hospitals provided services to patients, billed their health insurance plans and expected relatively prompt payment. This is no longer true. Today’s revenue cycle team members must be knowledgeable…
Engaging in operating rule development and adoption amidst the era of healthcare automation
Over the past two decades, the healthcare industry has collaborated to accelerate automation, alleviate administrative burdens and lower the cost of conducting common business transactions. Although much work remains to be done to streamline healthcare administration, the industry’s approach to developing and implementing operating rules to improve revenue cycle automation, independent of standards development, is…
Hospital payments have been substantially affected by the Change Healthcare cyberattack, report finds
Newly published data reflect the extent of the payment loss experienced by hospitals and health systems during the first month or so after the Change Healthcare cyberattack. A report (registration required) published in mid-May by Strata finds that gaps in expected revenue ranged from 16.5% to 17.9% per hospital for Q1. The insights were culled…
Bridging the gap: Integrating value-based care into revenue cycle management
The idea of value-based care (VBC) has existed for decades but only gained momentum since the 2017 implementation of the Merit-based Incentive Payment System (MIPS) and the Quality Payment Program (QPP). VBC incentivizes providers for quality outcomes, unlike fee-for-service models that reimburse providers for each service performed. The ultimate goal of VBC is to improve…
Annual report on Medicare financing could reduce the immediate impetus to address longstanding issues
New data on the state of Medicare funding show short-term improvement while keeping the stakes high for ensuing decades. The annual report from Medicare’s trustees shows the Hospital Insurance Trust Fund (i.e., Medicare Part A) has enough money to keep beneficiaries covered and providers paid through 2036. That’s an increase of five years from the…
Congressional hearings on the Change Healthcare cyberattack bring attention to providers’ continuing predicament
Two congressional hearings involving the CEO of UnitedHealth Group offered few concrete solutions to the issues surrounding the Change Healthcare cyberattack but did highlight the ongoing pressures facing healthcare stakeholders. Andrew Witty, the CEO, was questioned May 1 by the Senate Finance Committee in the morning and a House subcommittee in the afternoon. For providers…
Demonstrating revenue cycle excellence just got easier with the newest HFMA certification
The Executive of Healthcare Revenue Cycle (EHRC) certification, HFMA’s newest member recognition, has been quite popular with members since it was announced in mid-February. As of March 31, 22 HFMA members had applied for the EHRC certification and 18 members earned it, demonstrating excellence in revenue cycle, said Shirley Heavlin, certification operations manager for HFMA.…
Seeking to improve healthcare for Medicaid beneficiaries, CMS issues a flurry of regulations
CMS over the last month published a trio of final rules intended to make the Medicaid program work better for beneficiaries, with implications for healthcare providers. The three rules address eligibility and enrollment, access and Medicaid managed care. Streamlining eligibility and enrollment The first rule addresses administrative barriers in an effort to simplify enrollment processes…