The hype around Artificial Intelligence (AI) spiked again recently with the public release of ChatGPT. The easy-to-use interface of this natural language chat model makes this AI particularly accessible to the public, allowing people to experience first-hand the potential of AI. This experience has spurred users’ imagination and generated feelings ranging from great excitement to […]
In a win for physicians, a federal court for the second time in less than two years has rejected the government’s attempt to implement an independent-dispute resolution process that Congress created with the 2020 “No Surprises Act.” The Texas Medical Association (TMA) and others challenged the final rule, showing how language in it still favored […]
Prevention of readmission denials improves case mix index (CMI), reimbursement, and quality metrics. As a consultant, I am like the FBI – if you invite me in, I will likely take your case. This often leads to varied and challenging projects. Often, I am engaged to assess opportunity in provider documentation, clinical documentation integrity (CDI) […]
Using this technology to create the discharge summary is that the output is only as good as the input. A physician advisor once had a terribly unfortunate incident in which a pregnant patient died. This initiated a mandatory investigation by the Ohio Department of Health (ODH). This was one of those imperfect storms in which […]
The adoption of electronic transactions increased in 2021, but further automation of claims management processes could save healthcare providers nearly $25 billion annually. Automating claims management processes could help healthcare providers curb the high spending on administrative transactions they saw in 2021, according to the 2022 Index report from the Council for Affordable Quality Healthcare, […]
Erica Remer, MD, CCDS, a Member Board of Directors of American College of Physician Advisors, have been talking about improving the electronic medical record and making it more end-user-friendly. Today, she grouses about documentation in general. Her husband, who is a radiologist, and she were commiserating at how awful and uninformative provider documentation has become […]
The average health system saw 110,000 claim denials due to prior authorization and other factors in 2022, a recent study says. KEY TAKEAWAYS: Revenue cycle leaders are placing denials management at the top of the list of areas to improve for 2023. Denials rose to 11% of all claims last year, up nearly 8% from […]
One year ago, the United States marked a turning point for health care cost transparency with a new law aimed at helping Americans avoid unnecessary, unexpected medical debt. As of Jan. 1, 2022, health care providers and insurers are no longer allowed to sideswipe privately insured people with bills for out-of-network services. Experts say the […]
Medicaid expansion improved financial performance for healthcare providers and was associated with lower uncompensated care costs and higher revenues. Medicaid expansion has positively impacted healthcare providers by boosting financial performance and resulting in payer mix improvements, data from the Kaiser Family Foundation (KFF) found. All but 11 states have expanded Medicaid eligibility as of January […]
Here are four must-know key performance indicators that providers should know and use when looking to improve outcomes and the patient experience. Key performance indicators (KPIs) have always mattered, but they are now more relevant than ever in the healthcare industry, as providers make the shift to value-based care. While there are many common types […]