Features

Features

• Exploring the role of medical claim clearinghouses

  Medical claim clearinghouses manage claim submissions for providers, increasing efficiency, reducing costs and improving payment accuracy.  Continue Reading

• Unpacking the mid-revenue cycle, strategies for success

  The mid-revenue cycle includes coding, CDI, and compliance, making its processes vital to a provider organization’s success.  Continue Reading

• How Robotic Process Automation Optimizes Revenue Cycle Management

  Robotic process automation (RPA) saves practices money and time by automating manual, repetitive tasks within revenue cycle management.  Continue Reading

• Breaking Down the Back-End Revenue Cycle, Key Best Practices

  When a patient encounter ends, the back end of the revenue cycle gets busy creating claims and managing A/R to optimize revenue collection and integrity.  Continue Reading

• Highlighting Top Revenue Cycle Management Vendors By User Review

  The Best in KLAS vendors have been named; here are the top financial and revenue cycle management companies you should know.  Continue Reading

• The Role of the Hospital Chargemaster in Revenue Cycle Management

  The hospital chargemaster is how providers communicate medical bills to payers and patients and now plays an essential role in hospital price transparency.  Continue Reading

• Understanding the Basics of Bundled Payments in Healthcare

  Bundled payment models pay providers a one-time fee for a patient’s episode of care rather than reimbursing for each treatment, test, or procedure.  Continue Reading

• Understanding the Value-Based Reimbursement Model Landscape

  As value-based reimbursement models become more popular, providers must choose carefully to maximize revenue while maintaining high-quality care.  Continue Reading

• Breaking Down the Top 5 Healthcare Revenue Cycle KPIs

  Healthcare revenue cycle key performance indicators (KPIs) enable providers to track financial health and adjust for optimal revenue capture.  Continue Reading

• Understanding the Fundamentals of Accountable Care Organizations

  Accountable care organizations promote higher care quality at lower costs while shifting risk to providers, making the model a staple of value-based care.  Continue Reading

• Top 10 Accountable Care Organizations by Medicare Shared Savings

  The performance year financial and quality results are in, revealing a successful year for accountable care organizations in 2022.  Continue Reading

• Key Ways to Boost Collection of Patient Financial Responsibility

  How can healthcare providers redesign their medical billing processes to account for the steep rise in patient financial responsibility?  Continue Reading

• Exploring Front-End Revenue Cycle, How to Optimize Its Performance

  There is a lot that happens before claims management that impacts the revenue cycle. Optimizing front-end steps is vital to a provider’s financial success.  Continue Reading

• What Technologies Do Providers Need for Value-Based Care Success?

  As more healthcare providers get on board with value-based care, they must invest in technologies and resources to ensure success.  Continue Reading

• Key Types of Revenue Cycle Technology That Optimize Operations

  Revenue cycle technology takes many shapes and sizes depending on a provider’s need, but the tools have become essential to smooth revenue cycle operations.  Continue Reading

• What Payment Integrity Means for Providers, How to Avoid Claim Issues

  Payment integrity ensures accurate and timely reimbursement, but it takes robust documentation and coding practices, claims data analysis, and ongoing monitoring.  Continue Reading

• How Walmart Became a Major Player in the Healthcare Industry

  As Walmart Health expects to nearly double its healthcare footprint, the company is prioritizing community needs and affordable care—the notions that helped solidify its place in the industry.  Continue Reading

• Digging into CVS’ Latest Proposed Purchase: Oak Street Health

  Oak Street Health leverages a value-based model to provide comprehensive primary care and coordinated specialty care to seniors at over 160 locations.  Continue Reading

• Exploring the Role of Supply Chain Management in Healthcare

  Healthcare supply chain management leaders are looking to become more efficient and resilient as they continue to face significant supply chain disruptions.  Continue Reading

• The Most Successful Alternative Payment Models from CMMI, To Date

  The Center for Medicare & Medicaid Innovation (CMMI) runs over 50 alternative payment models and care delivery demonstrations, but not all have brought in net savings.  Continue Reading

• Assessing Progress on the Hospital Price Transparency Rule

  More than a year after the regulation went into effect, compliance with the hospital price transparency rule remains low, as hospitals are hesitant to invest in necessary software and resources.  Continue Reading

• How Healthcare Mergers, Acquisitions Impact Practice Management

  With an abundance of differing data, the industry remains divided on how healthcare mergers and acquisitions impact practice management, such as healthcare costs and patient quality of care.  Continue Reading

• Breaking Down Common CMS Value-Based Payment Programs

  To help improve patient health outcomes, CMS requires providers to participate in value-based payment programs, such as the Merit-Based Incentive Payment System and the Hospital Readmissions Reduction Program.  Continue Reading

• Coronavirus Healthcare Spending Dwindles, Threatening Health Equity

  Congress’s failure to allocate additional healthcare spending for uninsured COVID-19 claims is a blow to health equity, access to care, and patients’ lives.  Continue Reading

• What Is Value-Based Care, What It Means for Providers?

  Value-based care has emerged as an alternative and potential replacement for fee-for-service reimbursement based on quality rather than quantity.  Continue Reading

• Exploring the Fundamentals of Medical Billing and Coding

  Medical billing and coding are the backbone of the healthcare revenue cycle, ensuring payers and patients reimburse providers for services delivered.  Continue Reading

• What Is Healthcare Revenue Cycle Management?

  As the industry continues to transition from fee-for-service to value-based care reimbursement, healthcare revenue cycle management must adapt accordingly.  Continue Reading

• Top Healthcare Fraud, Waste, and Abuse Takedowns of the Year

  Here are some of this year’s largest healthcare fraud, waste, and abuse takedowns as reported by the Department of Justice.  Continue Reading

• Providers Dodged Major Medicare Payment Cuts But More Work To Be Done

  Healthcare providers are still up against significant Medicare payment cuts, including ones postponed by Congress, as well as financial losses from the pandemic.  Continue Reading

• Why Rural Providers Aren’t Transitioning to Alternative Payment Models

  A smaller percentage of rural providers are participating in Advanced Alternative Payment Models because of a lack of capital and data analysis capabilities, GAO reports.  Continue Reading

• The Role of Finance, Revenue Cycle in Advancing Health Equity

  CFOs and other healthcare finance leaders play a critical role in developing and executing health equity strategies, industry experts emphasized at HFMA’s Annual Conference.  Continue Reading

• 3 Hospital Price Transparency Strategies for Compliance, Patients

  Hospital price transparency is now a requirement from CMS, but providers should be going beyond the rule to ensure transparency meets patient demands, too.  Continue Reading

• What are Capitation Reimbursement Models, Key Strategies?

  As value-based care becomes more popular, capitation reimbursement models could help ensure care delivery is based on quality, not quantity.  Continue Reading

• Underserved Areas Get Higher CARES Act Provider Relief Payments

  CARES Act provider relief payments disproportionately went to medically underserved areas, helping providers in already struggling areas to keep their doors open during the peak of lockdowns.  Continue Reading

• What Healthcare CFOs Can Expect Under a Biden Presidency

  While Biden’s legacy under the Obama administration was tied to the Affordable Care Act, so will his presidency. COVID-19, value-based care, and price transparency will also mark the next four years.  Continue Reading

• Best Practices When Outsourcing Revenue Cycle Management

  Providers are facing one of the worst economic crises of modern times. Outsourcing full revenue cycle management to a third party could help some cut costs while focusing on patient care.  Continue Reading

• Top 4 Hospital Chargemaster Management Challenges

  Hospital chargemaster management comes with a host of challenges, but overcoming them is key to financial health and effective healthcare price transparency.  Continue Reading

• 3 Ways to Improve Medical Coding Quality for Accurate Reimbursement

  Leveraging technology, auditing for compliance, and providing robust education are key ways providers can improve medical coding quality.  Continue Reading

• Can Direct Primary Care Lead Private Practice Out of the Hole?

  Primary care practices are suffering losses of over $15 billion because of COVID-19 but direct primary care physicians are reporting little change in revenue and better patient and clinician satisfaction.  Continue Reading

• Healthcare Revenue Cycle Recovery After the COVID-19 Pandemic

  Financial losses from the COVID-19 pandemic will have lasting effects on providers but leveraging some of the capabilities developed during crisis can build a more resilient healthcare revenue cycle.  Continue Reading

• How COVID-19 Imperiled Physician Practices, And How to Save Them

  Physician practice revenue has been cut in half during the early part of the COVID-19 pandemic. Could telehealth and payment reform save the independent physician?  Continue Reading

• How Artificial Intelligence Is Optimizing Revenue Cycle Management

  Artificial intelligence is addressing some of the biggest pain points in revenue cycle management, leading to increased revenue capture and integrity for early adopters of the technology.  Continue Reading

• 4 Key Strategies for Accountable Care Organization Success

  Accountable care organizations play a critical role moving the care continuum toward value. But such complex contracting options make it challenging for ACOs to achieve success.  Continue Reading

• Entering the Next Phase of Value-Based Care, Payment Reform

  The healthcare industry has learned a lot from the past 10 years of payment reform for value-based care. Experts explore what the future holds for alternative payment models.  Continue Reading

• Healthcare CFOs Look Forward to Value-Based Care, Consumerism

  Healthcare CFOs need to be strategic partners, not just financial gatekeepers, for their organizations to succeed under value-based care and other new ways of doing business.  Continue Reading

• How Downside Risk Will Impact Participation in Pathways to Success

  ACOs must start weighing if the downside financial risk is worth the reward with the start of Pathways to Success pending.  Continue Reading

• Optimizing Healthcare Workforce Management for High-Value Care

  A comprehensive, sustainable healthcare workforce management strategy involves modernizing recruiting, using scheduling analytics, and lowering turnover.  Continue Reading

• Data Analytics Add Value to Healthcare Supply Chain Management

  Data analytics are offering innovative healthcare systems more visibility into supply chain management issues, allowing for reduced costs and greater efficiencies.  Continue Reading

• How Hospital Merger and Acquisition Activity is Changing Healthcare

  As value-based care takes over, hospital merger and acquisition activity is on the rise. But will these deals add measurable value to the industry?  Continue Reading

• Maximizing Provider Revenue with Payer Contract Management

  Improving payer contract management by analyzing terms and assessing payer performance can maximize revenue for healthcare providers.  Continue Reading

• Hospital Utilization Management Can Reduce Denials, Improve Care

  Comprehensive hospital utilization management programs are key to preventing claim denials and delivering the right care at the right time.  Continue Reading

• Overcoming Rural Hospital Revenue Cycle Management Challenges

  Rural hospitals face many unique revenue cycle management challenges, including health IT and value-based care.  Continue Reading

• Maximizing Revenue Through Clinical Documentation Improvement

  A strong revenue cycle rests on accurate, timely data. Clinical documentation improvement offers an opportunity to improve coding and maximize reimbursement.  Continue Reading

• Key Strategies for Succeeding with Healthcare Bundled Payments

  In order to succeed with healthcare bundled payments, providers must engage post-acute care providers, leverage data analytics, and improve their patient engagement strategies.  Continue Reading

• How Providers Can Detect, Prevent Healthcare Fraud and Abuse

  Providers should implement comprehensive compliance programs and improve medical billing processes to detect and prevent healthcare fraud and abuse.  Continue Reading

• The Difference Between Medicare and Medicaid Reimbursement

  Medicare and Medicaid reimbursement models vary according to federal and state regulations, but both are striving to embrace value-based reimbursement.  Continue Reading

• Leveraging Group Purchasing for Hospital Supply Chain Management

  Adopting group purchasing for medical supplies can streamline hospital supply chain management processes and reduce healthcare costs.  Continue Reading

• Best Practices for Value-Based Purchasing Implementation

  To implement value-based purchasing, healthcare organizations should ensure their staff have the right tools to manage alternative payment models.  Continue Reading

• Exploring Two-Sided Financial Risk in Alternative Payment Models

  Incorporating two-sided financial risk is key to making providers more accountable for their care. What do providers need to know before entering these alternative payment models?  Continue Reading

• Top Revenue Cycle Management Vendors and How to Select One

  Epic Systems and MEDITECH topped the revenue cycle management vendor list, but the market is expected to change in the next year.  Continue Reading

• How to Maximize Revenue with Improved Claims Denials Management

  Enhancing claim denials management strategies can help providers recoup lost healthcare revenue and maximize reimbursements.  Continue Reading

• Preparing the Healthcare Revenue Cycle for Value-Based Care

  The transition from fee-for-service to value-based care reimbursement has serious implications for healthcare revenue cycle management.  Continue Reading

• Using Revenue Cycle Analytics for Effective Value-Based Care

  The transition to value-based care requires a familiarity with revenue cycle analytics and population health management techniques.  Continue Reading

• Key Ways to Improve Claims Management and Reimbursement in the Healthcare Revenue Cycle

  To keep pace with changes to healthcare reimbursement, hospitals and healthcare organization need to reduce inefficiency in revenue cycle management.  Continue Reading

• Why Healthcare Needs Value-Based Supply Chain Management

  The ongoing shift away from fee-for-service into the value-based reimbursement realm should intensify healthcare providers’ focus on supply chain management.  Continue Reading