In April of 2019, the Centers for Medicare and Medicaid Services (CMS) announced it is rolling out a new set of CMS value-based payment goals. It’s called the CMS Primary…
Category: Assessment & Benchmarks
Revenue Cycle Management Process in Medical Billing – 5 Steps
Anyone who knows anything about medical billing knows there are serious issues when you’re trying to integrate a Revenue Cycle Management (RCM) process in medical billing. An essential understanding of…
Pay for Performance Reimbursement
The concept of pay for performance reimbursement isn’t new; it’s been circling the healthcare industry for over a decade. Yet, studies continue to show that it offers mixed results. In…
Outcome Based Reimbursement
Five years ago, most of the provisions of the Affordable Care Act came into play, and one of these provisions added outcome based reimbursement. It is designed to provide incentives…
Healthcare Revenue Cycle Process
The healthcare revenue cycle process is a non-organic process – non-organic because steps cannot be reversed, skipped or circumvented to save time or collect money faster. Missing or skipping a…
How does Fee for Service compare to Value Based Reimbursement
The cost of medical care has outpaced inflation for several years now, and it shows no signs of slowing. Despite skyrocketing costs, care quality is not improving under the traditional…
Revenue Cycle Management Outsourcing
According to a recent Black Book Survey, revenue cycle management outsourcing stood at $11.7 billion at the close of 2017 and is expected to climb to $23 billion by 2023….
Healthcare Revenue Cycle Flowchart in 5 Steps
Healthcare revenue cycle management is a complex and complicated process that can drain resources when not properly managed. It takes considerable time and expertise to create and manage a well-maintained…
Value Based Care Reimbursement
A recent Black Book survey found that hospitals and other providers are gearing up to outsource key functions, including a move to outsource revenue cycle management to third-party vendors. Medical…
A Medical Billing Audit can Increase Profitability
A Medical billing audit is often thought of as a defensive measure. A government or private payor has denied or pended a series of claims. Now they want copies of…
Physician Revenue Cycle Key Indicators of Best Practices
Physician revenue cycle operations continue to transform fundamental aspects of modern medical practice. The current unsustainable system drafts individual elements of the revenue cycle in search of success, often ignoring…
What is Value Based Reimbursement Looking Like in 2019?
Change is a constant in the healthcare industry, and for all healthcare providers submitting claims to Medicare it’s important to carefully review your processes based on what’s to come with…
Hospital Revenue Cycle Best Practices for Profitability
Hospital revenue cycle management inefficiencies cost providers millions each year in lost income, and this is a single provider (and on average) estimate. When you examine hospitals collectively, this figure…
Healthcare Revenue Cycle Management Automation
Healthcare revenue cycle management needs to be automated! Revving up the revenue cycle or optimizing cash flow by cutting down on the time between patient-related services and monetary collections is…
Value Based Reimbursement – Are you prepared?
Is value based reimbursement replacing Fee-for-Service (FFS)? FFS has been the standard in patient care for decades. The focus on revenue cycle best practices was and will continue to be…
MIPS, are you ready? The Merit-based Incentive Payment System.
As mentioned in a previous blog, MACRA combines parts of the Physician Quality Reporting System (PQRS), Value-based Payment Modifier (VBM), and the Medicare Electronic Health Record (EHR) incentive program into…
How to Start a Medical Practice – it’s a business, too!
How to start a medical practice . . . . When I was being interviewed for an article about billing and accounts receivable recently for Dermatology World magazine, I was…
What is MACRA?
The roll out of MACRA (Medicare Access and CHIP Re-authorization Act) is expected to proceed, regardless of changes in the Affordable Care Act. MACRA is part of a broader push…
Medicare Payment Overhaul – Finally!
Senate Action on the “Doc Fix” On April 14, 2015 the Senate acted on a bill from the House of Representatives to implement a Medicare payment overhaul, including repealing the…
Even Hospital Billing Done Correctly can have Claims Denied by a RAC
Convinced that your hospital billing department is doing its job well, and yet your claims get denied by a RAC? You’re not alone. Did you know that in one study…