Healthcare Revenue Cycle Management, Reimbursement, HIPAA, and Insurance Information Gathering Resources Healthcare Revenue Cycle Management, Reimbursement, HIPAA, and Insurance Information Gathering Resources

FEATURED ARTICLES: REVENUE CYCLE MANAGEMENT

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CASE STUDIES & WHITE PAPERS

  • The Age Of Consumerism: Taking Charge Of Healthcare Spending

    Payers and providers must adopt new industry models to meet customer needs.

  • Payer And Provider Solutions For The Revenue Cycle Of The Future

    The healthcare industry’s transition to value-based payment models is rapidly progressing. Unsustainable, rising healthcare costs—reaching $3 trillion in 2014i—are pressing both government and commercial payers to control costs by improving efficiency and reducing waste. Payers, in turn, are pushing providers to take on greater risk and move to value based reimbursement models.

  • Bundled Payments For Care Improvement (BPCI) Benchmark Survey

    Caradigm recently conducted a survey of healthcare organizations in order to better understand how providers are approaching bundled episodes of care. Although some providers have been piloting bundled episodes for several years, most are still in the early stages of refining their strategies and increasing their participation in The Centers for Medicare and Medicaid Services (CMS) Bundled Payment for Care Improvement (BPCI) program.

  • Unified Reimbursement Strategy: Implementing Common Ground Among Next-Generation Reimbursement And Quality Systems

    We may look back on the 25-year span following the change of the millennium as one of the most densely populated periods of healthcare regulation ever seen in the history of the United States. Every year, individual clinicians, private practices, and health systems are bombarded with new coding, compliance, quality, and reimbursement models, making staying ahead of the curve in terms of overall strategy nearly impossible. Executives, physicians, and healthcare experts would probably agree that it is impossible to maintain a status quo level of performance if your strategy is one of pure reaction to each new deadline from the Department of Health and Human Services.

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FROM THE EDITOR'S DESK

  • The Problem With Consumerism In Healthcare
    The Problem With Consumerism In Healthcare

    Many industry leaders championed a free market approach to healthcare during the 12th Annual World Health Care Congress last week. Here are a few key reasons why I don’t think this model is “the fix” our industry so desperately needs.

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REVENUE CYCLE MANAGEMENT PREMIUM CONTENT

  • Medical Moneyball — What Healthcare Stands To Learn From The Oakland A’s
    Medical Moneyball — What Healthcare Stands To Learn From The Oakland A’s

    With all the talk of Big Data, there are still big questions as to how to most effectively leverage information and data to make a positive impact on healthcare delivery, cost, and outcomes. One health system leader thinks an approach developed by a Major League baseball team might be a game changer.

  • Top 10 Health IT Trends For 2016
    Top 10 Health IT Trends For 2016

    For the past five years, EHR/MU was selected as the top health IT initiative for the coming year. This year, there’s a new top initiative, and what it is should come as no surprise.

  • A Road Map To Accelerating  Health IT Value And Innovation
    A Road Map To Accelerating Health IT Value And Innovation

    Health IT is in a state of constant evolution, and it often seems that, for every problem solved, another is created. That’s why it’s vital we stop to assess where the industry stands from time to time, as well as look to the future to determine the best course to take to achieve our collective goals.

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RCM (REVENUE CYCLE MANAGEMENT)

At its core, revenue cycle management (RCM) is the process that ensures healthcare providers are efficiently reimbursed for the services they provide. The most significant parts of the process includes tracking patient claims, collecting payment for each claim, and handling claims that are denied for various reasons. To accomplish this goal, RCM systems must tightly integrate claims data, clinical data and IT infrastructure.

RCM systems track patients’ interactions with providers as they enter a hospital or arrive for a scheduled physician’s appointment. From that initial contact point, the RCM system tracks claims at every point on its way to resolution. This allows the process to be monitored by providers and gives them the ability to address any issues or delays that might arise. This RCM transparency ensures a steady revenue stream for healthcare providers. 

RCM includes insurance information gathering, insurance eligibility verification, payment guarantor identification, ICD-10 claims coding, co-pay collection, and medical necessity verification to ensure timely and accurate payment.

INDUSTRY EVENTS

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