How one health system focused on revenue cycle staff education to improve its denial rate
Many longtime revenue cycle leaders can recall a simpler time when insurance companies sold plans that were broadly accepted by providers in their service areas. Back then, hospitals provided services to patients, billed their health insurance plans and expected relatively prompt payment. This is no longer true. Today’s revenue cycle team members must be knowledgeable…
What health systems need to know about partnering to develop an ASC strategy
Health systems must contend with conflicting imperatives. While remaining intensely focused on day-to-day operations and financial viability, they cannot ignore longer-term strategic imperatives, which may include building out a full continuum of care to succeed under value-based payment while maintaining market relevance. Yet many health systems face significant impediments to broadening the continuum of care,…
Not-for-profit health systems need a new enterprise strategy
Based on findings of recent original research, the current financial performance of not-for-profit (NFP) health systems raises concerns over their long-term financial viability. The research findings underscore the need for NFP health system leaders to reconceptualize their organization as comprising six strategic business units (SBUs) and then manage each in terms of competitiveness. Research findings…
How to promote patient loyalty by improving network integrity
To achieve enduring financial stability, health systems must pursue initiatives to improve margins. And a particular priority for them is to focus on improving the integrity of their provider networks, with the goal of building patient loyalty to the larger healthcare organization. The first step in such an effort should be to perform a network…
How providers can optimize payer contract negotiations
Negotiating payer contracts can be both challenging and frustrating. Payers have significant leverage at the bargaining table, enhanced by payer consolidations and the emergence of dominant local, regional and national plans. But by adopting a transparent data-driven strategy in negotiations with a payer, a provider organization can create an opportunity for building a strong partnership…
8 healthcare trends for 2024: A guide for health system leaders and their boards
As health systems progress through 2024, they will require effective governance to successfully navigate the rising headwinds. As they plan and execute initiatives, their leaders and boards should remain informed about eight key trends that will have a growing impact on the industry and the future success of their organizations. 1 Continued big technology M&A…
How a payer-provider collaboration around quality reporting can reduce costs and improve outcomes
Too often today, relations between provider and payer organizations can become contentious around issues related to payment and quality of care. Yet such conflict does not serve patients well, because it deflects these organizations’ attention from their underlying shared purpose: To work together to deliver well-coordinated, cost-effective healthcare to patients. With this purpose in mind,…
How CFOs can bring the rigor of finance to the call center
Health system call centers are universally acknowledged as significant cost centers. Too often, however, they are viewed as non-revenue-generating cost centers. In fact, a call center’s performance also affects revenue growth factors such as clinician utilization and patient loyalty. Despite the multiple ways that call centers affect both the bottom and top lines, there is…
4 common misconceptions about observation that have revenue implications
Among the many things that healthcare providers must document, few are as misunderstood and cause as much confusion as observation. Clearly, observation is often required as part of diagnosing and treating a disease or condition. The challenge for providers is that ambiguity and variability in regulatory and contract language create confusion regarding how to record…
Can MRF data be used for comparative benchmarking?
The impetus for the MRF requirement — as outlined by the U.S. Department of Health & Human Services (HHS) in its 2019 hospital price transparency final rule — was to enable informed decision-making about healthcare services based on their pricing, thereby helping to drive down the cost of healthcare. Yet significant obstacles continue to block…