Adventist, Ascension and LifePoint Share Their Experience with Revenue Cycle Outsourcing
R1 RCMJuly 6, 2023
Every night since the pandemic, countless healthcare financial leaders from around the country have spent sleepless nights contemplating their biggest concerns: rising operating costs, optimizing the use of new technology, navigating the labor market, and improving the patient experience. ...
Understanding the PEPPER: “My Patients are Sicker than Everyone Else’s Patients”
Dr. Ronald HirschJune 21, 2023
We have all heard it, time and time again. In fact, I recall telling my hospital’s chief medical officer that my patients were sicker than others to explain why my average length of stay was longer than those of other internists on the medical staff. The difference, of course, was that for my patients, it was true, but not for the other ...
Minimize Claim Denials with Effective Denials Management
Lucy ZippleJune 8, 2023
Denial prevention and effective denial management strategies are key to maximizing the revenue potential for the healthcare services you provide to your patients.
Six Pitfalls to Avoid in a Healthcare Call Center to Drive More Cash
R1 RCMMay 19, 2023
It’s no secret that running an efficient modern healthcare call center can be a struggle. Health systems are currently facing unprecedented challenges, including skyrocketing costs, high labor shortages and increasingly more money left uncollected, resulting in monumental losses and long-term negative margins.
Why Prior Authorization Reform Should Garner Provider Support
R1 Regulatory TeamApril 14, 2023
In the United States, prior authorization (“PA”) is a cost-containment tool utilized by payers to reduce payment for medically unnecessary or inappropriate patient care. Despite its laudable policy goals, the use of PA faces
The Power Behind the HFMA Peer-Reviewed Status
Abby BirchMarch 3, 2023
Dear Health Leaders,
In the world of revenue cycle ...
A Post-Mortem on Medical Necessity Criteria – Not So Fast
Dr. Ronald HirschFebruary 24, 2023
The proposal from the Centers for Medicare & Medicaid Services to codify the requirement that all Medicare Advantage plans use the Two-Midnight Rule for determining admission status of all patients has some talking that the use of commercial criteria will become obsolete. ...
RACmonitor: Warning: Medicare Rates Up in 2023
Dr. Ronald HirschJanuary 27, 2023
EDITOR’S NOTE: Listen to Dr. Ronald Hirsch’s live reporting Monday on Monitor Mondays with Chuck Buck at 10 Eastern.
The Future of Good Faith Estimates Under the No Surprises Act
R1 Regulatory TeamJanuary 18, 2023
The No Surprises Act of the 2021 Consolidated Appropriations Act (“NSA”) established requirements for healthcare providers to deliver Good Faith Estimates (“GFEs”) for scheduled services or upon patient request.
Key Takeaways:
- Indefinite extension of co-provider and co-facility enforcement ...
Hospital Price Transparency: Lessons Learned, Best Practices
R1 Regulatory TeamDecember 19, 2022
Federal price transparency requirements for hospitals from the Centers for Medicare & Medicaid Services (CMS) provide patients with an unprecedented amount of insight into the costs for medical services.1
In theory, more pricing information should ...
