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, […]
Data was big in revenue cycle challenges long before “Big Data” was a buzzword. The same goes for the challenges that come with it. For years, revenue cycle challenges for leaders have looked for answers to common hurdles like missing or incorrect charges, payment file problems, and data transfer timing delays. Big Data and advanced […]
There are the standard reasons medical claims are denied, such as putting the wrong modifier on a code or putting the diagnoses in the wrong sequence. But did you know that some reasons are not the fault of medical coding? 5 Ways Your Medical Claim Can Be Denied Denials can be cause by more than an […]
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 […]
Healthcare is a top priority for American voters and there aren’t dramatic differences by ideology, according to a new survey. Adopted from the marketing industry, customer segmentation allows health systems to further customize the patient financial experience and help them get paid. Key Takeaways Tailor billing strategies and patient payment options to a financial situation […]
Proposed rules also include new payment models. The Centers for Medicare & Medicaid Services (CMS) has been quite busy these last few weeks issuing the proposed payment rules for 2020 and making some other announcements. Here is an update on other regulatory activities of interest. On April 22, 2019, the CMS Innovation Center announced the […]
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 FY 2020 Inpatient Prospective Payment System (IPPS) proposed changes could bode well for many facilities. There has been much discussion about the Centers for Medicare and Medicaid (CMS) Inpatient Prospective Payment System (IPPS) for fiscal year (FY) 2020 proposed rule and its suggested changes. Good news can be found in the 1,824 pages of […]
Patients’ appeal a denial are often shocked when their insurance company denies coverage for a procedure or treatment, especially if that leads to a bigger-than-expected bill. These rejections can be fairly common, and people may not put up their best fight to get the decision reversed. Odds are tough, but claim denials can be resolved […]