Revenue Cycle Management

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.

Some states have found practical success in establishing the Affordable Care Act, but what distinguishes their efforts are their unique fit within each state's distinctive political and business climates.

A new federal regulatory proposal to ensure adequate insurance networks could help not-for-profit hospitals, Moody's said in a briefing released this week.