Final rules will impact nearly every type of healthcare provider. The Centers for Medicare & Medicaid Services (CMS) presented us with quite a number of Medicare payment rules in the last week or so, referencing almost every type of provider in the program. The final rules included the Fiscal Year (FY) 2020 Medicare Hospital Inpatient […]
Medical necessity denials continue to be a pain point for revenue cycle leaders, so much so that HBI members reported medical necessity as one of the top three root causes in 2016, 2017, and 2018. While denials and appeals are typically housed within the revenue cycle, there are many other teams—including clinical staff, utilization review, […]
Hospitals and health systems are exploring ways to revenue cycle transformation processes to offset financial pressures. However, shifting to a new business model for revenue cycle management can be challenging. The hospital revenue cycle has become increasingly complex in recent years for several reasons, including the shift away from fee-for-service medicine, the adoption of advanced […]
For many healthcare providers, claim denials are a frustrating cost of doing business. Each year, around 5-10% of medical billing claims are rejected (possibly more). With each claim costing around $25 to rework, providers lose billions in eroded revenue and productivity. Any revenue leakage is bad enough, but the shift towards value-based care means tighter revenue cycle management […]
The U.S. healthcare industry has a $1 trillion opportunity to cut costs and reduce waste, according to a 2015 Harvard Business Review analysis. While there are various areas waste accumulates, costly data reconciliation is a prominent problem for hospitals and health systems. Change Healthcare defines data reconciliation as “the process of compiling information across companies […]
Even as recently as five years ago, the revenue cycle outsourcing process took on a very different form to that of today. For years, most organizations saw the revenue cycle as little more than a cost center – meaning that revenue cycle outsourcing was a decision made largely from an administrative perspective. It was seen […]
As patients take on more out-of-pocket costs, and patient satisfaction continues to influence the financial health of hospitals, revenue cycle management has become increasingly important to organizations. Amid these and other changes, many revenue cycle professionals have offered thought-provoking insights. Here are 10 RCM tips from industry experts: 1. “To make sure that your organization […]
Revenue cycle management refers to the business side of your practice—from verifying patient insurance eligibility to submitting claims to receive health plan payments and billing patients for their share of service costs. Although patient care will always be your top passion and priority, an efficient revenue management system is critical for your practice’s financial health […]








