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

  • Improving Revenue Cycle Performance With Comparative Analytics
    Improving Revenue Cycle Performance With Comparative Analytics

    How can you determine whether your organization’s business performance is clicking on all cylinders? Many organizations have invested in business intelligence tools to help measure their internal performance, evaluate areas in need of improvement, and identify best practices. Yet, what exactly are “best practices” and how can an organization know if their practices truly are best? By Chris Bodam, RemitDATA

  • Revenue Cycle Management: The Key To Achieving Success Under MACRA

    The Medicare Access and CHIP Reauthorization Act (MACRA) aims to improve physician and other clinician payments by changing the way Medicare incorporates quality measurement into payments. At its core, the Act repeals the sustainable growth rate and authorizes the U.S. Department of Human and Health Services (HHS) to implement value-based incentives. Regardless of MACRA’s original intent to improve healthcare for both patients and physicians, the new legislation can result in negative implications on practices — particularly as it relates to revenue cycle management.

  • Roadmap To Cost Savings By Improving Care Variation

    To improve margins, healthcare providers must bend the cost curve to reduce wasteful spending as the industry moves from fee-for-service to value-based payments, while facing the prospect of declining reimbursement. However, many provider organizations do not know or understand where they may be losing money due to deviation from commonly accepted clinical based guidelines. By Susan Kanvik and Mitzi Raaf, Point B Management Consultants

  • Simplify Excel-Based Revenue Cycle Operations To Improve Collection Rates And Accelerate Reimbursement

    Healthcare offices are often overwhelmed when attempting to manage data for efficient operations, especially in the finance/billing department. By Frank Moreno, vice president of product marketing, Datawatch

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CASE STUDIES & WHITE PAPERS

  • 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?

More Case Studies & White Papers

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.

More From The Editor

REVENUE CYCLE MANAGEMENT PREMIUM CONTENT

  • 2015 Health IT Change Agents
    2015 Health IT Change Agents

    Our inaugural class of Health IT Change Agents set a high bar, but this year’s class can more than hold its own when it comes to driving positive change and advancing health IT.

  • 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.

  • 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.

How The Internet Of Things Is Revolutionizing Healthcare

From notifying care givers of proper bed rail placement for patients with a high fall risk to directing patients to their medical appointments, the possibilities of the Internet of Things (IoT) in healthcare are truly endless.

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.

More From Health IT Outcomes Magazine

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.

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