The United States grapples with a healthcare affordability crisis, anticipating a 6.5 percent surge in costs due to inflation next year. Amidst concerns over escalating medical expenses, the deeper roots of these inflated prices often evade attention. Deficient government policies, notably Medicare reimbursement policies, contribute to consolidating the healthcare sector, ultimately driving up costs that […]
The Senate Finance Committee proposed that the full chamber should review a legislation that could instigate alterations in physician practices. This proposition was discussed during a 90-minute meeting on November 8, 2023, regarding the bill named “The Better Mental Health Care, Lower-Cost Drugs, and Extenders Act.” This bill encompasses diverse aspects of healthcare, including mental […]
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 […]
Getting shots into arms has been a top priority for healthcare providers since the federal government gave the green light to several COVID-19 vaccines. But while speed was key for immunizers, medical coding efficiency has taken a major hit. At the heart of the issue is the way two major COVID-19 vaccines were created, Amber […]
Part IV in this series discusses expanding HIM’s visibility and enhancing organizational processes via authorization denial management. In my prior article, I discussed the value of payer policy management, and mentioned that “no authorization” denials represent 10-15 percent of all denials. This focused denial category presents another opportunity for health information management (HIM) professionals. HIM […]
Physicians enter into health care because they want to help care for patients, not to become business people. This can make revenue cycle management (RCM) seem like an overwhelming or complex set of steps, yet, at its essence, “it is basically about obtaining payment for services rendered to a patient,” says Kelly Dingwell, principal attorney […]
Claims denials can be frustrating for a physician practice to deal with, but leaving them unattended leaves a significant amount of revenue uncollected, says Andria Jacobs, RN, CPHQ, chief operating officer at PCG Software. Her company develops healthcare applications focused on cost containment, fraud and abuse detection, based in Las Vegas, Nev. Jacobs says that […]
The COVID-19 pandemic has been devastating across all areas of health and business. Physician practices, for example, on average are reporting a 55% decrease in revenue and a 60% decrease in patient volume, according to the results of a Medical Group Management Association survey. Nearly all surveyed medical groups (97%) report a negative financial impact […]
Doctors are fond of complaining that they didn’t go to medical school in order to practice business, but independent physicians do spend much of their time on their practices’ finances. That requires mastering revenue cycle management (RCM), the financial process practices use to administer all the functions associated with claims processing, payment, and revenue generation. […]