Revenue Cycle Management

Changing eligibility standards could purge a million or more beneficiaries from Medicaid rolls in California. A lawsuit seeks to stop the state from canceling coverage for Medi-Cal recipients who haven't been properly notified.

As more new patients come into the healthcare system, savvy providers are seeing opportunities to develop better relationships with the hope that it will translate to greater bill collection success.

For many Americans, the ACA open enrollment period offers them an opportunity to have health insurance for the first time. But for hospitals and healthcare organizations, ACA open enrollments create financial and operational challenges.

Bon Secours Health System wants to ensure discharged patients get the care and attention they need without being unnecessarily readmitted to the hospital. To that end, they're launching a new population health and care management program.

Although CMS paused the RAC audit program in March, hospitals must remain vigilant. The agency has promised a new round of recovery auditor contracts will be awarded before the end of 2014.

Hospitals dependent on Medicaid disproportionate share allocations must discover new financing models for low-income patients, or else lobby their state governments to make policy changes.

Hospitals' struggle for financial sustainability continues and may be getting worse, as CFOs say information technology investments draw more resources than expected and threaten to crowd out other priorities.

Hospitals and health systems want to mitigate their compliance spend as much as possible, as well as reduce the odds of facing large penalties for being out of compliance. The path to lowering the costs of compliance starts with putting appropriate policies and procedures in place -- and getting the right people at the table to make that happen.

It's the rare hospital that has never experienced delays in receiving reimbursement as a result of clinical documentation coding snafus. But hospitals that don't make a serious stab at clinical documentation improvement (CDI) will be poised to take an even harder hit come October 2015, the start date for ICD-10 implementation.

The CY 2015 final rule for the home health prospective payment system updates Medicare payment rates to home health agencies, and implements the second year of the four-year phase in of the rebasing of the payment system.