Overview of Denial Management: How Understanding, Strategizing, and Preventing Denials Can Boost Your RCM

When commercial payers deny medical claims, it takes a bite out of a healthcare organization’s annual revenue. According to Modern Healthcare, this loss, nationwide, totals to an estimated $262 billion. Today, claim denials are a significant contributor to the myriad of financial/net revenue challenges that have impacted US hospitals, healthcare providers, and patients alike.

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Denial Management: Why Healthcare Providers are Struggling

With many healthcare organizations transitioning from a fee-for-service to value-based-care payment model, some recent market trends have spiked the urgency of such facilities to enhance their denial management processes. Struggling to collect outstanding payments and rework denied claims, organizations are facing more challenges than ever as they attempt to ground denial management, decrease overhead, and…

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Rethinking Denials Management: How Data Analytics Can Boost Revenue

In the modern landscape of technologically-supported, value-based healthcare, many providers have reoriented focus on their claims denials management program. The efficiency of those programs, however, can vary significantly across organizations; the effect of denied and delayed rendered claims can be detrimental to the bottom line of healthcare facilities who lack a strategic, holistic approach. An…

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CMS Assists Rural Hospitals with RCM Issues

Hospitals in rural communities are more prone to revenue cycle challenges, ranging from physician shortages and hospital closures to a higher degree of uninsured patients. The solutions for such complex problems are not universal to healthcare reform; rural communities are unique. The CMS Rural Health Summit has identified healthcare institutions in rural settings as the…

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Outsourcing RCM: Considerations for Your Healthcare Organization

Revenue cycle management (RCM) is crucial to a healthcare organizations financial organization and success. By utilizing RCM’s medical billing software, providers can track the entirety of the patient care process, from registration to appointment scheduling and final payments. With the new age ICD-10 and a growing level of financial responsibility, many medical employees are working…

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Why Should You Outsource Revenue Cycle Management?

There are more reasons to outsource your revenue cycle management today than ever before. Stringent regulations, escalating costs, and the shift to value-based reimbursement models have each helped to saddle physicians with heavy burdens. Because of their high-deductible health plans, there are more patients who are responsible for their out-of-pocket costs than there had been…

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Why are Revenue Cycle Systems Important for Value-Based Care?

In 2008, the Affordable Care Act launched a series of sweeping system-wide reforms that have had a major impact on the healthcare industry. One major development has been the progressive shift from a fee-for-service system to a value-based care system. With the previous fee-for-service orientation, hospital revenue depended on the number of services offered to…

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Revenue Cycle Management: 5 Ways to Improve

1. Minimize the need for collections by asking patients for their payments upfront.Create a checklist for your staff to follow with regard to procedures for copying insurance cards, verifying patients’ data, collecting payments, and confirming contact information. Your staff members may know the basics, but are they consistently performing them? Consistency is key. Alternatively, make…

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6 Tips On How to Improve Your Collection Rates for Small Balance Claims

As the healthcare industry continues to change and evolve, many hospitals are trying to adapt in order to maintain or increase their profits. With the increase of health plans featuring high deductibles and increased pressure on reimbursement rates, many health systems and hospitals have begun looking for any ways they can find to improve their…

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Hospitals Need to Monitor These 5 RCM Metrics In Order to Improve Their Cash Flow

If hospitals wish to maintain or improve profitability, there are certain things they need to keep an eye on when it comes to revenue cycle management. There are specific metrics that can be monitored which will allow hospitals to get the maximum amount of reimbursement possible, as well as enhancing the effectiveness of their billing…

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