From the inception to the conclusion of the Revenue Cycle Management (RCM) pipeline, it is imperative for practices to implement enhanced analytics and streamlined workflows. Healthcare providers have grappled with the challenge of receiving proper compensation for their services, and the current reimbursement landscape presents even greater obstacles compared to previous years. Payors are persistently […]
Numerous pre-claims management factors significantly influence the revenue cycle, underscoring the critical importance of optimizing front-end processes for a healthcare provider’s financial prosperity. The healthcare revenue cycle comprises three distinct phases: the front-end, mid-cycle, and back-end. While significant attention is often given to mid and back-end functions, such as coding and billing, claims management, and […]
The process of medical billing encompasses multiple stages, starting with patient registration and eligibility verification, followed by capturing charges, coding, submitting claims, and posting payments. When a patient receives medical services from a healthcare provider, the provider documents the services and associated costs within an electronic health record (EHR) system. Subsequently, a medical billing entity […]
To ensure both financial stability and operational efficiency, revenue cycle leaders must reinforce three essential areas. The challenges of grappling with low operating margins, diminished reimbursements, and escalating costs will persist throughout 2024. In an era where a subpar financial journey could overshadow a top-tier clinical experience for patients, the burden on revenue cycle leaders […]
Access to beneficial healthcare is largely tied to insurance reimbursements for many Americans. Yet, despite their significance, physicians encounter various obstacles in obtaining these payments. Challenges involve inconsistent reimbursement schedules, payment audits, billing errors, unforeseen denials, lengthy appeals, and services falling outside coverage. These issues can hinder timely care, disrupt service continuity, and leave medical […]
The Centers for Medicare & Medicaid Services (CMS) have released the Final Rule for Inpatient Rehabilitation Facilities (IRFs) on July 23. The new rule updates payment policies, IRF Quality Reporting Program (QRP) requirements for the 2024 fiscal year (FY), and modifies the conditions for Excluded Units. This allows hospitals to open a new IRF unit […]
A Guide to Accounts Receivable (A/R) The healthcare practice’s Accounts Receivable (A/R) encompasses various complexities and subtleties. The Accounts Receivable process is continually evolving, presenting numerous challenges. Although A/R challenges may not solely determine success, improving A/R turnaround time can have a significant impact. Based on an MGMA Stat poll, 56% of medical groups reported […]
Physicians and healthcare experts are urging Medicare to lead reforms in the time-consuming prior authorization (PA) process, which often causes delays in patient care. However, they caution against excessive reform, as it could exacerbate the problem rather than improving it. The U.S. Centers for Medicare and Medicaid Services (CMS) have put forth two proposals for […]
Prompt payment to healthcare providers for their services is crucial for a detailed discussion on managing macro costs, quality, and equity. Without it, addressing the issue of rising healthcare costs becomes challenging. Healthcare providers are well aware that getting paid is not an easy task. A quick search for revenue cycle management (RCM) reveals 16-step […]
Revenue cycle technology comes in various forms, tailored to the specific needs of healthcare providers, yet these indispensable tools have become vital for ensuring seamless operations within the revenue cycle. The healthcare revenue cycle represents a vast and intricate operation that encompasses a range of activities, from patient registration and insurance verification to denials management […]