Here comes the Medicaid unwinding: The healthcare industry braces for coverage disruptions
A potentially tumultuous period for revenue cycle teams in particular and the U.S. healthcare system in general begins April 1, with the phasing out of a three-year run of Medicaid continuous enrollment. The so-called Medicaid “unwinding” originally was connected to end of the COVID-19 public health emergency (PHE), which is scheduled for May 11. But…
Data capture and coding for social determinants of health are works in progress, per reports
In the effort to bring social determinants of health (SDoH) more under the purview of healthcare providers, one tricky aspect is establishing a data and coding infrastructure. Recent reports highlight this challenge. For example, a survey conducted for the American Health Information Management Association (AHIMA) found that although 78% of 2,637 respondents said their organizations…
Navigating payer practices to reduce denials and enhance outcomes
The friction between payers and providers has existed for decades. It’s understandable to an extent. Payers want to reduce expensive and unnecessary treatment, eliminate fraud and lower financial risk. Providers want to be able to make decisions regarding their patients’ care without having to navigate the hurdles of medical necessity, prior authorization and complex payer…
Affordability of healthcare is not enhanced when providers form health systems, studies find
The efficiencies gained when providers operate as a health system don’t always translate to care that is more cost-effective, according to two recently published JAMA studies on pricing. In one study, researchers with Harvard Medical School and the National Bureau of Economic Research (NBER) examined 2018 data from various sources, including CMS administrative data, IRS…
Collecting with compassion: Patient financial care grows in importance
Health system leaders increasingly believe more communication is better when it comes to telling patients what they owe. When the pandemic began, Henry County Health Center’s revenue cycle department took a gamble to relieve the financial stress of care for patients. Executives for the 25-bed, Mount Pleasant, Iowa, critical access hospital, which serves a large…
Hospitals require an integrated team approach to ensuring revenue integrity
Hospital and health system finance teams should not view payment audits and denials as being solely their concerns. Instead, these issues require an all-hands-on-deck approach.
Monument Health revamps its revenue cycle leadership structure for the benefit of patients and the organization
Looking to break through the cultural silos that can hamper operations at hospitals and health systems, Monument Health has engineered a new brand of clinical-finance collaboration. Headquartered in Rapid City, South Dakota, the community-based health system established a dyad leadership structure in which a clinical leader has joint oversight of the revenue cycle. It’s a…
How R1 RCM’s technology-driven solutions address health system challenges
Seeing challenges in labor shortages, shrinking margins and other complexities? Enter technology-driven solutions for revenue cycle management. Read the details in this peer review spotlight.
4 reasons why now is the time to revisit value-based care
Lessons from the pandemic, investment trends, shifts in Medicare policy, and technological change suggest that now may be the time to reconsider and revisit value-based care. Value-based care has been a hot topic for years now. Every conference, every industry meeting and every publication has talked about the importance of moving “from volume to value.”…
Hospital price transparency update: Regulatory enforcement soon could become stricter, CMS leaders say
Although nothing is official, CMS leaders indicate enforcement of hospital price transparency regulations is set to become more stringent. For an article published in Health Affairs, the Center for Medicare’s Meena Seshamani, MD, PhD, director, and Douglas Jacobs, MD, chief transformation officer, touted progress that has been made since the rules took effect Jan. 1,…