Revenue Cycle Management

While some health systems are reluctant to publish prices without reforms of insurance practices and proper context for patients, some are trying to embrace transparency as a new model. Washington State's Everett Clinic is one of those pioneers.

Following an "industrial model of care," New York's Westmed Medical Group analyzes data from more than 2,200 processes and procedures to drive accountability and results. This has led to 15-fold growth and $285 million in annual revenue.

Commercial insurers inaccurately process about 20 percent of claims filed by medical practices. It's an industry standard that has weathered the test of time -- though not in a good way.

The offical transition to the ICD-10 coding set takes place next October (or so we hope). Many providers have already spent a good deal of money preparing for the inevitable, but even so, you need to make certain that select ICD-10 costs are included in your 2015 budget.

Significant inpatient pricing variation between hospitals in the state of Washington is "putting some consumers at financial risk," according to a recent study by the Washington Health Alliance. But the state's hospitals are questioning the report's conclusions, claiming that price variation should not be surprising.

Physician practices have the lowest revenue growth in the healthcare industry. When every dollar counts, anything from a lost referral to a bad online review can impact profitability. Here are some common revenue leaks and tips on plugging them.

While reducing reliance on expensive inpatient care is a sensible goal for hospitals, the transition away from a bricks-and-mortar, fee-for-service model is creating tremendous pressures on chief financial officers.

With an improving fiscal climate, some states are paying their Medicaid providers more. More states are increasing fees to specialists, nursing homes and managed care organizations, but 31 states were cutting or freezing Medicaid hospital rates, compared to 19 that were increasing them.

Most hospitals fall well short of their cost reduction targets, in part because the ability of chief financial officers to meaningfully impact how operational and clinical leaders approach the issue is limited.

New research suggests that socioeconomic factors can account for most of the geographical variation in Medicare spending. As a result, larger socio-demographic issues must be considered when assessing the quality of care offered by healthcare providers.