Claims Processing
Although it may be tempting to rely on the status quo when it comes to payer payment, opportunities exist to boost collections by shifting key activities upfront and leveraging revenue-driving tools and processes on both the front and back ends of the revenue cycle.
The Affordable Care Act's online insurance exchanges launched this weekend with far fewer problems and less fanfare than last year. Many people qualified for federal subsidies that kept their monthly premiums well under $100.
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.
Healthcare providers can expect an increase in medical claim denials after Oct. 1, 2015. But that doesn't have to mean that revenue will be lost.
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.
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.
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.
Like many other industries, healthcare is looking to leverage information technology to transform financial payments and automate the posting of accounts payable and accounts receivable processing systems. But which method to choose?
Some health systems see value in becoming part of branded health plan networks for limited provider plans, as other providers try to launch their very own plans.