Despite ongoing concerns about denials and beneficiary access to care, Medicare Advantage (MA) companies remain in the spotlight as their market penetration continues to grow. In April 2022, a report from the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) highlighted a significant issue in the capitated payment model employed […]
The Children’s Health Insurance Program (CHIP) was established under the Balanced Budget Act of 1997 (BBA 97) to offer health insurance to children from low to moderate-income families who were ineligible for Medicaid but couldn’t afford private insurance. The program grants federal funding to states, enabling them to establish and enhance their own programs, and […]
In the intricate dance of healthcare administration, few steps are as frustrating and resource-intensive as denials management. Every rejected claim represents lost revenue, increased administrative burden, and potentially delayed or denied care for patients. In today’s challenging healthcare landscape, marked by shrinking margins and increasing regulatory complexities, a proactive and efficient approach to denials management […]
To enhance the financial experience of patients, it is crucial to closely examine an organization’s billing procedure. HealthLeaders is joining the celebration of Patient Experience Week from April 23-29 by highlighting the efforts of revenue cycle leaders in establishing a favorable financial experience for patients in their organizations. With a suboptimal financial experience capable of […]
Insufficient implementation of revenue cycle management (RCM) strategies may result in disorderliness. Conversely, optimizing RCM in conjunction with billing and collection procedures can mitigate the difficulties, leading to amplified revenue for the practice. The Role of RCM in the Healthcare Sector RCM encompasses both the clinical and business aspects of healthcare institutions, linking patient care […]
Revenue cycle leaders were asked to rank the most time-consuming tasks at their organization, and the results aren’t surprising. 556 chief financial officers and revenue cycle leaders at hospitals and health systems across the United States were asked to rank the most time-consuming revenue cycle tasks at their organizations in a new survey commissioned by […]
Two letters. They’re enough to give your patients more anxiety than any treatment, test or injection. A recent survey by the Pew Research Center shows it: Sixty percent of Americans said they would be uncomfortable with their provider relying on artificial intelligence (AI) in their own health care. But when used responsibly, artificial intelligence can […]
CMS proposed a new rule for the fiscal year 2024 Inpatient Prospective Payment System (IPPS) increased hospital payment rates up to 2.8%. Also, the newly proposed IPPS rule adopts policies that are aimed at advancing health equity. Under CMS’s new FY24 IPPS rule, hospital market basket update of 3.0 percent, less a projected 0.2 percentage […]
The number one priority of management, executive, and ownership level business is learning when and how to delegate responsibility. When it comes to revenue cycle management, the evolving healthcare industry almost requires that medical professionals take full account of their administrative capacity. Although keeping this aspect of business in the house may seem like a […]
How do you resolve a repeated and shooting up problem like claims denials? It’s been a fresher subject for revenue cycle management professionals for years that are only experiencing hotter with the growing pressures of staffing shortages, troubles with staff movement and instructing and developing policies and protocols at the government and payer levels. On […]