Tag: RCM

Hospitals Use Supply Chain Analytics to Recover from COVID-19 Losses

Hospitals Use Supply Chain Analytics to Recover from COVID-19 Losses

The COVID-19 pandemic has challenged healthcare networks throughout the U.S. in unprecedented ways. As financial losses are being surveyed, new opportunities have emerged for hospitals and health systems to not only recover from those losses, but also simultaneously establish cost-saving initiatives in the perioperative area by using optimized supply chain analytics. Healthcare organizations are also recognizing the […]
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Mastering Revenue Cycle Management

Mastering Revenue Cycle Management

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. […]
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Artificial Intelligence The Benefits to Revenue Cycle Management

Artificial Intelligence: The Benefits to Revenue Cycle Management

Artificial intelligence (AI) is a concept that has moved very quickly from the realm of science fiction into real and practical utility in a number of different industries—including healthcare. One of the most effective applications for AI-powered tools is in the field of revenue cycle management. Sophisticated AI technologies can sift through vast amounts of […]
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New Patient EM Denials

New Patient E/M Denials: Mystery Solved

New patient evaluation and management (E/M) claims are being denied when the patient was previously seen by a specialty physician assistant or specialty nurse practitioner on staff. This is happening when another provider of a different specialty in the same multi-specialty group sees the patient for the first time and bills a new patient E/M […]
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CMS Delays OPPS Claim Edits For Off-Campus Provider-Based Depts

CMS Delays OPPS Claim Edits For Off-Campus Provider-Based Depts

OPPS claim edits slated to take effect this month will now start in October to give providers more take to adjust to billing changes for off-campus provider-based departments. CMS is postponing the implementation of outpatient prospective payment system (OPPS) claim edits that would require hospitals and health systems with multiple locations to list provider addresses […]
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Medical Necessity and Denial Management

Medical Necessity and Denial Management

Quality work reduces the burden of the denial management process. When my children were young, they really enjoyed the movie “The Neverending Story.” It’s about a boy who reads a magical book that tells a story of a young warrior whose task is to stop a dark force called “The Nothing” from engulfing a mystical […]
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Top 3 Challenges To Revenue Cycle Transformation

Top 3 Challenges To Revenue Cycle Transformation

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 […]
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The Facts Surrounding The Coding Chronic Kidney Disease

The Facts Surrounding The Coding Chronic Kidney Disease

Chronic Kidney Disease (CKD) is a serious health condition affecting millions of people worldwide. In the United States alone, 15% of adults, or approximately 37 million people, suffer from CKD. This condition, often insidious in its onset, can lead to severe complications and significantly impact quality of life. Key Facts about CKD: Prevalence: More common […]
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