Revenue Cycle Management
Many not-for-profit hospitals are still struggling to align revenue with capital deployment and expenses, a challenge that may grow as patients come in covered by exchange plans and Medicaid.
As a result of the push towards accountable care, increased patient census no longer translates to higher revenue for hospitals. Unless costs are managed internally, higher patient volume may instead lead to narrower margins, if not outright red ink.
To get ready to participate in integrated care funded by bundled payments, behavioral health providers need to establish a new business model, with particular emphasis on establishing episode of care rates.
The decision by lawmakers to delay implementation of ICD-10 by a year will give hospitals extra time to get ready for the transition, but will have a negative financial impact.
With Medicare's "two midnight rule" set to take effect later this year and audit appeals facing lengthy backlogs, the Recovery Audit Contractor program may be headed in some new directions.
The House of Representatives passed a bill yesterday to forestall scheduled cuts to Medicare physician payments through April 1, 2015, to delay the ICD-10 implementation deadline for one year, and to suspend enforcement of the controversial two-midnight policy.
The quality of a hospital or health system is usually linked to patient outcomes, not to administrative or financial efficacy. But smooth interactions between patients and the hospital business office should also be viewed as critical to an organization's quality, says one CFO.
As Oregon transforms how it delivers care to 780,000 Medicaid patients, it hopes to generate better outcomes at lower costs. The problem for Oregon hospitals is that these goals conflict with the traditional aim of boosting revenue through ER visits and inpatient stays.
Now that health plans are required to be compliant with the newly adopted operating rules for electronic funds transfers and electronic remittance advice, electronic transactions might be poised to overtake healthcare.
As legacy revenue cycle systems struggle to keep up with constant regulatory changes, many hospitals are turning to next generation revenue cycle systems out of necessity, but experts caution to think before jumping.