CMS audits for risk adjustment

When CMS proposed expanding the risk adjustment audit program in 2015, it was looking to cover all Medicare Advantage (MA) Plans, annually.  CMS wanted one of two conditions:

1. Condition-Specific
2. Comprehensive Audits

CMS wanted one of the two implemented due to the fact that the powers at be then, strongly believed that the diagnosis data was fraught with epic upcoding mistakes which were being submitted by all the MAorganizations.  This was a concern for CMS as they were concerned that there would be significant misallocation of resources.  Some MA Plans might be overpaid on their members and some might be underpaid on their members.

Read More: https://goo.gl/1MEZ9t

Handles Patient Statements, Follow The Socrates Method

Socrates, one of the greatest thinkers of the age, was surely not thinking about Revenue Cycle Management when he wrote this, however, it surely can apply! When you think about this phrase in terms of Revenue Cycle Management, we can say that there are many things that have been done the same way in many practices for many years, for the shear reason of, “we have always done it this way”

There are lessons to be learned when you decide to clean up the old and focus on the new – one aspect of RCM, is Patient Statements,  Often overlooked and underworked properly.  I worked with a practice that had a statement problem, to the tune of about 500 statements we inherited when they signed up for our services.  As the Account Manager for this practice, I took a look at the statement process and discovered that out of the 500, about a fourth of them, were repeatedly being sent out since 2014/2015 for “No Show” fees of $25.00 a piece. I then discovered that there were another fourth that were also for 2014/2015, due to balances equal to $5.00 or less.  The next batch were comprised of about another 50 statements that had Credit Balances on them and also had not been worked since 2014/2015.  Second to last, were about 90 statements that had actual balances due, but had never been collected, also from 2014/2016 and then finally the rest were 2016 (at that time the current year).  The total reflected by all these patient statements was a whopping $75000.00 uncollected as it initially appeared.

10 reasons 2017 is going to be the year of Automating AR Functions

2017 is the year of big changes. The healthcare industry is waking up to the benefits of blockchain technology, interoperable systems and value based payments. And most importantly of automating operational and financial processes to cut back on costs and increase efficiency.

Still stuck with outdated processes?

According to a survey by Practice Profitability Index, declining reimbursement (60%) and rising costs (50%) top the major concerns of healthcare providers. Complex and time-consuming processes aggravate the downward pressures faced by medical practices. Smart practices are automating key revenue cycle functions such as AR processes to cut down on costs and manual efforts.

Read More: Systematic AR Processes

  

   

12 organizations providing MACRA Support for small practices

Hardly a week goes by in the healthcare industry without a major regulation hitting the headlines. MACRA is the latest healthcare reform that is forcing medical practices to rethink their clinical and financial strategies. Healthcare providers are desperately looking for MACRA support. We list out 12 trusted MACRA support providers who offer MACRA assistance for small medical practices and EPs. Equip your medical practice to face the challenges and seize the opportunities MACRA provides by making an informed choice.

Read More: MACRA Support

Here’s what 2016 taught healthcare CFOs about revenue management

Battling reimbursement challenges, shrinking margins and compliance hurdles hospitals are exploring options to cut back on costs and increase revenue. The decision to work with professional revenue cycle management companies can be tied back to the bottomline pressures healthcare organizations face. A survey by Black Book reflects this trend.

According to the survey 54% of healthcare CFOs believe outsourcing will help them improve their financial health. And that the outsourced RCM market is growing at a 27% rate. 49 percent of hospital CFOs said outsourcing, including offshoring, is becoming an extremely viable option in 2017.