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


  • How To Get Comfortable With Alternative Payment Methods
    How To Get Comfortable With Alternative Payment Methods

    Healthcare payment models are evolving, and it is vital healthcare providers evolve along with them. Although change can be stressful, this shift represents an opportunity for providers to operate more efficiently while also increasing the quality of care.

  • Unravelling The Mysteries Of Medical Billing With Artificial Intelligence

    When you go to the grocery store and make a purchase, the receipt you receive at the end of your visit is fairly self-explanatory. By David Bayer, Vice President, Compreno Group at ABBYY

  • Why Credentialing And Provider Enrollment Matter In The Move To Value-Based Care

    In today’s ever-evolving healthcare environment, many practices are struggling to keep up with rising costs and quality of care demands. With the move from a fee-for-service payment model to a value-based payment model, these demands have significantly increased.

  • Your Billing System Needs An Overhaul: How To Make A Successful Transition

    Every commercial entity wants to get paid fairly for the work it produces, and health systems and hospitals are no exception. Recently, as waves of payment reforms have swept through the industry, reimbursements have generally shrunk and consequently so have margins. This has put a much sharper focus on improving the effectiveness of billing and collection, and provider organizations have been investing a lot of time and money in trying to improve their performance.

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  • 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.

  • Streamlining Revenue Cycle Management For Improved Efficiency And Financial Outcomes

    Many healthcare organizations are advancing beyond the implementation of electronic health record (EHR) solutions and are now faced with new challenges: how to improve the health information exchange and to enhance the overall financial performance of the care facility. It has become imperative that providers, payers, and patients have expedited accessibility to health information.

  • Revenue Cycle Management: Is Your Process Under Control?

    When it comes to the revenue cycle, do you have it covered, or could it be time to consider turning over certain processes to a trusted partner?

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  • 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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  • The Troubling State Of EHR Progress
    The Troubling State Of EHR Progress

    When attestations for Stage 1 of the EHR Meaningful Use (MU) program began in 2011, it seemed like the healthcare industry was on the right path to ushering in a fruitful digital era that would benefit clinicians and patients alike.

  • The Right Time To Implement RTLS
    The Right Time To Implement RTLS

    Waiting for the “next big thing” before proceeding with an IT implementation can be a lesson in futility. Geisinger Health System faced such a conundrum when choosing an RTLS (real-time location system) solution, and here’s what they did to expedite the process.

  • Countdown To ICD-10
    Countdown To ICD-10

    After repeated delays, it now appears ICD-10 will become a reality Oct. 1. As the clock ticks, healthcare providers are focused on testing and preparing physicians and staff for the changes.

Medical Practice Increases Revenue 18% By Streamlining Patient Billing

As patients incur more out-of-pocket healthcare expenses, they are becoming more price-conscious. Medical practices such as Urology of Greater Atlanta are responding by retooling the revenue cycle to determine patient responsibility and collect payment up front.

Secure Clinical Communications Makes Real Patient Impact

MemorialCare Health System’s new secure clinical communications solution has done more than streamline communications among physicians. It has helped decrease patient wait times and length of stay as well.

Improving Price Transparency With IT

Providers are leveraging technology and enhancing education efforts earlier in the treatment process to better inform patients of their financial responsibility while gaining a competitive business edge.

CIO Struggles And Triumphs

From outdated technology to changing culture, three healthcare CIOs share their thoughts on the daily struggles they are facing and how they are overcoming them.

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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.