elenabs/istock via getty images
Healthcare RCM, Medicare Reimbursement Dominate 2017 Stories
Our top 10 stories from 2017 included topics on the basics of healthcare revenue cycle management and Medicare reimbursement and strategies for improving both.
From the Quality Payment Program’s launch to the Affordable Care Act debate, the healthcare finance world saw an abundance of change and uncertainty in 2017. In the face of payment reform and political debates, healthcare leaders focused on ensuring their organizations built a strong healthcare revenue cycle management foundation that could withstand any possible changes.
The pursuit of healthcare revenue cycle management and Medicare reimbursement success overwhelmingly dominated RevCycleIntelligence.com headlines this year. As politicians and healthcare stakeholders debated health policy, providers were uncertain how their bottom lines would be affected.
Value-based care is almost certain to survive healthcare reform in 2018, but reimbursement models are likely to shift gears. CMS already canceled several proposed bundled payment models and announced an agency-wide shift to voluntary alternative payment models.
Similarly, potential changes to insurance coverage may impact bottom lines. Ensuring a healthcare organization has the foundation in place to mitigate uncompensated care costs and greater patient financial responsibility is key to overcoming any insurance coverage changes.
2017’s most clicked stories also centered on Medicare reimbursement trends. The Quality Payment Program launched at the start of the year, turning Medicare reimbursement on its head. Understanding how Medicare reimburses providers was a top of priority for many healthcare stakeholders.
Below is our annual countdown of the most read articles on RevCycleIntelligence.com in 2017:
10. How the 21st Century Cures Act Impacts Medicare Reimbursement
The Obama administration signed the 21st Century Cures Act into law at the end of 2016. The law was a win for supporters of precision medicine, telemedicine, mental health reform, and drug innovation. And some lauded the law as “the most important legislation” Congress passed in 2016.
But the 21st Century Cures Act also contained several important Medicare reimbursement policy changes. Key reimbursement policies in the law included site-neutral payment exceptions, socioeconomic adjustments in value-based reimbursement models, new billing codes to bridge outpatient and inpatient surgical procedures, and suspension of the 25 Percent Rule for long-term care hospitals.
9. What is the Medicare Shared Savings Program Track 1+ Model?
CMS unveiled a new Medicare Shared Savings Program (MSSP) track late in December 2016. MSSP Track 1+ builds on the program’s largest track, which contains upside-only financial risk.
The new track ramps up financial risk arrangements and acts as a bridge for assuming downside risk in Tracks 2 and 3. Participating ACOs will take on limited downside financial risk, making the track suitable for smaller ACOs.
MSSP Track 1+ will also qualify as an Advanced Alternative Payment Model (APM) under the Quality Payment Program. Participants may earn maximum incentives payments by joining the track in later years of the program.
8. Top 4 Claims Denial Management Challenges Impacting Revenue
Approximately $262 billion of total hospital charges in 2016 were initially denied, Change Healthcare recently reported. With a considerable amount of revenue on the line, readers aimed to understand the major challenges providers are facing with claims denial management.
Automating denials processes, staying on top of payer changes, and proactively correcting claim submissions are among the top methods for healthcare organizations to reduce claim denials and write-offs.
7. 4 Medical Billing Issues Affecting Healthcare Revenue Cycle
At the heart of healthcare revenue cycle management is medical billing. But manual billing processes, greater patient financial responsibility trends, and inaccurate coding and clinical documentation can strain healthcare revenue cycles.
Overcoming major medical billing challenges will help organizations streamline their revenue cycles and ensure providers receive what they are owed for providing high-quality services. Here we explore the top four obstacles of medical billing that are putting pressure on healthcare revenue cycles.
6. The Difference Between Medicare and Medicaid Reimbursement
Medicare and Medicaid are the largest payers in the country. In this resource, we examine how reimbursement structures vary by program and some of the payment complexities within Medicare and Medicaid.
But providers should not get too comfortable with each program’s reimbursement structures. Medicare and Medicaid are moving to value-based reimbursement. We explore how each program aims to achieve value-based reimbursement goals in the next couple of years.
5. Breaking Down the Top 5 Healthcare Revenue Cycle KPIs
Healthcare organizations are always seeking ways to track and improve their financial health. Key performance indicators (KPIs) are metrics that help healthcare organizations measure their financial performance in specific areas and compare scores to their peers.
The Healthcare Financial Management Association’s Director of Healthcare Finance Policy and Revenue Cycle MAP, Sandra Wolfskill, shares what the top five KPIs are for healthcare organizations to track and improve revenue cycle management.
4. What Is Value-Based Care, What It Means for Providers
What is value-based care? How can providers participate in value-based reimbursement models? And how successful has the shift away from fee-for-service been?
Value-based care is here to stay in healthcare. Here we unpack the future of healthcare and what providers need to know to be successful with value-based care models from bundled payments to accountable care organizations.
3. Nurse Practitioner, Physician Assistant Salary Grew in 2016
Readers continued to express interest in how much nurse practitioners and physician assistants made in the past year. Last year, reports on physician assistant demand and their rising compensation rates dominated headlines.
Healthcare organizations were just as interested in the pay increases of the advanced practice clinicians this year. Providers and organization leaders may be curious to know how much they should be paying nurse practitioners and physician assistants as value-based reimbursement models promote team-based care that relies heavily on the help of advanced practice clinicians.
2. 3 Most Common Healthcare Supply Chain Management Challenges
Ensuring that the supply chain is operating efficiently is key to reducing the second largest expense for healthcare organizations. However, common obstacles may be creating kinks in healthcare supply chains.
Provider preference items, lack of supply chain data, and hidden costs are all healthcare supply chain issues that organizations should address to reduce their costs and improve operational efficiency.
1. What is Healthcare Revenue Cycle Management?
The most read article on RevCycleIntelligence.com in 2017 examined the basics of healthcare revenue cycle management and top strategies for improving financial health. Optimizing healthcare revenue cycle management strategies never goes out of style. Healthcare organizations are always seeking methods to reduce total costs of care and improve operational efficiency.
Understanding each component of the healthcare revenue cycle is key to identifying opportunities for improvement and implementing best practices.
