The vital relationship between MDs and clinical documentation integrity
High-quality clinical documentation is vital for creating a complete picture of a patient’s health and medical history. Accurate records of diagnoses, medications, tests, treatments and other elements of a patient’s care are crucial in creating the most effective care plan leading to positive outcomes. The quality of a physician’s clinical documentation can also impact payer…
Bridging the gap: Integrating value-based care into revenue cycle management
The idea of value-based care (VBC) has existed for decades but only gained momentum since the 2017 implementation of the Merit-based Incentive Payment System (MIPS) and the Quality Payment Program (QPP). VBC incentivizes providers for quality outcomes, unlike fee-for-service models that reimburse providers for each service performed. The ultimate goal of VBC is to improve…
Navigate the new norms in telehealth billing and coding practices
While telehealth has been around for decades, its adoption soared during the COVID-19 pandemic. According to the American Medical Association, telehealth use grew 70% in 2020. While the use of telehealth since then has leveled off, it remains a valuable and popular care option. More than half of patients surveyed said they prefer telehealth for…
Strategies for success: Tackling common clinical documentation integrity challenges head-on
Clinical documentation, which includes a record of exams, symptoms, diagnoses, medications, tests, treatments and other elements of a patient’s medical care, plays a vital role in creating a complete picture of an individual’s health and is needed to develop effective care plans. It also ensures that all providers who see the patient have access to…
Empowering patient access teams: The transformative impact of training and development
Hospital patient access teams are often the first encounter a patient has with the hospital. The patient access encounter sets the stage for the entire patient experience and has financial implications as well. Effective registration, eligibility verification, coverage discovery and collection workflows are required for optimal revenue cycle outcomes. Training and development have a big…
3 key interventions to address lagging payer reimbursements
It seems as if commercial payers are doing all they can to keep from reimbursing providers in a timely manner. According to a recent report by Crowe, 31% of claims submitted to commercial payers in the first quarter of 2023 were not paid for at least three months, as compared with 12% of Medicare claims.…
How predictive analytics and AI shed light on payer behavior
Providers and payers have become more collaborative as payment models evolve toward value. Still, payer-provider relationships can seem one-sided — decidedly in favor of the payer — as hospitals continue to face declining reimbursement and rising costs. The increase in denials is a great example, with rates skyrocketing by 20% over 5 years, according to…
4 opportunities to improve mid-cycle revenue operations
The quality of a hospital’s revenue cycle processes directly impacts the health of its bottom line. In an age of stagnant margins, hospitals should do all they can to improve revenue cycle efficiency. The mid-cycle—that critical phase between patient registration and claims submission — is a great place to start. Numerous challenges arise during this…
7 KPIs providers should be tracking
Health systems and provider organizations are facing enormous challenges. In a recent poll, providers ranked five of their most pressing issues, which were staffing (58%), expenses (20%), revenue (17%), technology (2%), and other (2%), according to the MGMA. The poll also found that costs have been outpacing revenue for nine in ten respondents. In addition…
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…