Ask the Experts

Ask the Experts

• How Top Accountable Care Organizations Save Year After Year

  Accountable care organizations continually save on post-acute care and hospitalizations. But how the providers do that has evolved over the years, while new strategies have emerged.  Continue Reading

• How FTC’s New Merger Retrospective Program Will Impact Healthcare

  The revamped program will expand the FTC’s retrospective research efforts, which could signal increased scrutiny of certain healthcare merger deals in the future.  Continue Reading

• How Independent Practices Can Come Out of COVID-19 Stronger

  The economic fallout of COVID-19 may accelerate acquisitions of independent practices unless practice leaders consider new, but not necessarily novel, ways of doing business.  Continue Reading

• Major Changes Coming to BPCI Advanced Clinical Episodes, Prices

  In less than four months, CMS will implement new ways of setting target prices and selecting clinical episodes under the BPCI Advanced to prevent significant financial losses down the road.  Continue Reading

• Health Systems Considering Remote Revenue Cycle Management

  A new survey found that 75% of health systems and large hospitals are considering permanent changes to revenue cycle management due to COVID-19, including more work from home positions.  Continue Reading

• Preparing for Hospital Price Transparency Rule Compliance

  In the latest Healthcare Strategies podcast, a healthcare lawyer explores hospital price transparency rule compliance and different strategies for solving the healthcare cost problem for patients.  Continue Reading

• Is the Doctor’s Office Dead? Practice of Primary Care Goes Virtual

  The office-based business model has led to massive financial losses during COVID-19, while virtual primary care providers have been able to remain operational.  Continue Reading

• In the Final Hours, Providers Prepare for Repayment of Medicare Loans

  Starting on or near Aug. 1, providers will have to start repaying over $100 billion in Medicare loans taken out at the start of the COVID-19 pandemic despite ongoing financial hardship.  Continue Reading

• Beyond the Pandemic: Telemedicine Reimbursement and Health Policy

  Telemedicine reimbursement and other regulatory flexibilities enabled providers to quickly pivot operations for COVID-19, but temporary policies also poised the health policy landscape for significant change after the pandemic.  Continue Reading

• Efficiency Key to Health System Financial Stability After COVID-19

  As Eisenhower Health reopens following the peak of COVID-19, leaders are leaning on technology and strategies that improve efficiency to ensure health system financial stability during the recession.  Continue Reading

• How Value-Based Payments Support Physicians During a Crisis

  Value-based payments support telehealth, data analytics, and other capabilities providers need to effectively respond to crises like COVID-19, says SWHR's Sanjay Doddamani, MD.  Continue Reading

• Mending Payer Relations Smooths Revenue Cycle at Northwestern Med

  Engaging in more productive conversations with payers helped Northwestern Medicine exceed net patient revenue goals and address its more pressing revenue cycle challenges, including COVID-19.  Continue Reading

• How Nebraska Medicine Avoided Furloughs During COVID-19

  As providers make drastic spending cuts due to COVID-19, Nebraska Medicine is leveraging labor and productivity data to redeploy staff and prepare for future challenges to its operations.  Continue Reading

• CareMount’s Foundation for Accountable Care Organization Savings

  Data analytics, care coordination, patient communication, and physician engagement were CareMount’s building blocks for success as a first-year Next Generation accountable care organization  Continue Reading

• How University Hospitals Is Resuming Elective Surgeries

  Hospitals have stopped elective surgeries due to COVID-19, but teamwork, data, and testing are helping University Hospitals meet pent-up demand now that the peak has passed in Ohio.  Continue Reading

• Should Physician Practices Return Paycheck Protection Program Loans?

  Many physician practices are considering returning Paycheck Protection Program loans by the May 14 deadline, but new guidance may change their minds.  Continue Reading

• Adapting Patient-Friendly Medical Billing to a COVID-19 World

  Monument Health in South Dakota is adapting to a new definition of patient-friendly medical billing as COVID-19 transforms patient needs and their ability pay for healthcare.  Continue Reading

• Few States Have Robust Healthcare Price Transparency Laws

  Only 6 states require healthcare price transparency from providers, carriers, or both, while 33 states have no laws around healthcare price transparency, a new report shows.  Continue Reading

• What Providers Need to Know About COVID-19 Coding and Billing

  The healthcare system is facing an unprecedented crisis, but accurate COVID-19 coding and billing can help providers weather the storm and prepare for future outbreaks.  Continue Reading

• AMGA Seeks Payroll Relief for Medical Groups Impacted by COVID-19

  The association called on the Treasury Department and Small Business Administration to allow medical groups to access forgivable loans to cover payroll during the COVID-19 pandemic.  Continue Reading

• Home Hospital Reduces Costs, Readmission for Acutely Ill Patients

  Home hospital care can reduce readmission rates and improve cost savings, according to a recent randomized controlled trial.  Continue Reading

• Playing Defense Key to Overcoming Fiscal Challenges of COVID-19

  Hospitals should identify liquidity and other opportunities to lower costs to remain financially healthy during the coronavirus outbreak, a financial expert says.  Continue Reading

• Documentation to Ease Medical Billing Issues Due to COVID-19

  A healthcare lawyer advises providers to thoroughly document care delivery to prevent medical billing and payment issues likely to arise from the COVID-19 pandemic.  Continue Reading

• Private Equity Firms Increasingly Buying Physician Practices

  New research shows that acquisitions of physician practices by private equity firms more than doubled over a 3-year period.  Continue Reading

• The Role of the Accountable Care Organization in Value-Based Care

  Accountable care organizations were developed to push the healthcare industry toward value-based care. But the model is not the final solution, industry experts say.  Continue Reading

• How Social Media Helped an Accountable Care Organization Save $50M

  Borrowing from Amazon, Facebook, and LinkedIn, an accountable care organization in Texas leveraged a HIPAA-compliant communications platform to improve care coordination.  Continue Reading

• What the Latest ACO Numbers Mean for the Future of the MSSP

  With lower than average participation rates in 2020, ACO leaders expressed concerns for the viability of the Medicare Shared Savings Program (MSSP).  Continue Reading

• How Nebraska Medicine Boosted Revenue Cycle Efficiency

  Automating key financial processes was key to allocating resources and improving revenue cycle efficiency at the large academic health system.  Continue Reading

• Hospitals Retain 91% of Profit from Physician-Administered Drugs

  Hospital keep a greater share of the gross profit margin on physician-administered drugs, indicating a need to level the playing field for physician practices, according to some experts.  Continue Reading

• Making APMs Truly Value-Based Through Person-Centered Care

  Alternative payment models do not truly incent value-based care unless providers are accountable for delivering person-centered care, an industry expert says.  Continue Reading

• Atrius Health Makes the Business Case for Risk-Based Payments

  The Massachusetts-based medical group ended 2018 with a $38.7 million operating after tying 75% of its revenue to risk-based payments.  Continue Reading

• Exploring Hospital Chargemaster Management Best Practices

  Accurate codes and prices and automation are hospital chargemaster management best practices that will help hospitals weather new price transparency rules.  Continue Reading

• How Advocate Aurora Health Streamlined Prior Authorizations

  The health system reduced the burden of prior authorizations while upping medication adherence by automating the process in the EHR and creating an authorization team.  Continue Reading

• Machine Learning Improves Patient Collections at Allina Health

  Allina Health saw a $2 million patient collections boost after using machine learning to develop a propensity-to-pay model and personalized collection strategies.  Continue Reading

• Major Health Systems Create New Company to Tackle Drug Shortages

  CHI’s System VP of Pharmacy shares how Civica Rx, a non-profit generic drug company, will disrupt the hospital pharmacy supply chain to solve drug shortages.  Continue Reading

• Aligning the Healthcare Revenue Cycle with Patient Experience

  Implementing self-service technology and giving accurate price estimates is key to improving the patient experience while ensuring a smooth revenue cycle.  Continue Reading

• 4 Hospital Business Models for Consumer-Centric Healthcare

  Healthcare consumerism is changing how hospitals operate, resulting in new hospital business models that will help providers meet consumer demands and remain competitive.  Continue Reading

• End-to-End Revenue Cycle Management Key to Success at Ascension

  Implementing an end-to-end revenue cycle management solution helped Ascension standardize financial technology and best practices across its 151 hospitals.  Continue Reading

• RCCH Uses Predictive Analytics to Boost Claim Denials Management

  A Tennessee-based healthcare organization uses predictive analytics to identify high-value denials and add accountability to their claim denials management strategy.  Continue Reading

• Artificial Intelligence Ensures Payer, Provider Pay Covers Costs

  Gateway Health Plan is using artificial intelligence to improve its risk adjustment programs, which ensure the payer and its providers receive reimbursement that covers a patient’s total cost of care.  Continue Reading

• A Provider-Sponsored Health Plan Is A Hospital’s Natural Next Step

  Geisinger Health Plan's CFO views a provider-sponsored health plan as a hospital's "natural next step," but providers need to think long-term with their plan to be successful.  Continue Reading

• Transforming the Hospital Laboratory into a Profit Center

  Executives oftentimes view the hospital laboratory as a cost center, but RWJ University Hospital transformed its lab by implementing an analytics-driven outreach program.  Continue Reading

• Physician Advisors Crucial to Navigating Reimbursement Rules

  Physician advisors act as a bridge between providers and other staff to improve clinical documentation, utilization review, and claim denials management.  Continue Reading

• Physician Expert, Clinical Documentation Key to MIPS Success

  An industry expert advised practices to develop physician-led MACRA implementation teams that emphasize clinical documentation improvements for MIPS success.  Continue Reading

• Top 5 Ways to Optimize Healthcare Revenue Cycle Management

  Financially clearing patients is becoming an important part of revenue cycle management, as it helps hospitals and clinics avoid debt collection.  Continue Reading