Thursday, September 7, 2017

What is Revenue Cycle Management Transparency’s Role in Keeping Healthcare Facilities Afloat?

While it’s true that patients are the lifeblood of any healthcare provider, it’s the accounts receivables that keep the proverbial chimneys burning. After all, if billings are not collected on time, your clinic or hospital may very well find itself short on cashflow. This, in turn, can have catastrophic effects on both your bottom line and your ability to service the infirm.

The Possible Problems

Of course, there many reasons why medical facilities can’t bill accounts receivables in a timely manner. The first and most common reason is that patients simply do not have the financial capacity to pay their medical bills. Such a problem can be alleviated by engaging the services of an eligibility expert, which can help your patients identify what government-sponsored programs they qualify under so that the government—and not third-party payers—will reimburse you. Read more from this blog:

Revenue Cycle Management Companies Advise a Data-Centric Approach to Increasing Collection

Improving operational efficiency can definitely help reduce a hospital's total costs. But, just as importantly, if not more, it can noticeably improve the quality of care that patients receive, thereby minimizing their need to keep returning to the hospital for more treatments.

To explain how this is possible, revenue cycle management companies turn to some of the most recent studies conducted in several health clinics across America. Mostly, these studies focus on the importance of accessing data in a timely manner. Read more from this blog:

Monday, September 4, 2017

Rethinking Revenue Cycle Management Services in the Face of Bundled Payments

There has never been an era when the healthcare industry has seen such an upheaval quite like the past decade. With the passing of the landmark Affordable Care Act (ACA), millions of previously uninsured Americans now have a safety net to rely on should they fall ill.

However, the influx of new patients also means that there has been a renewed focus on providing quality care. On the flip side, providing quality care also often means higher costs of treatment. Now more than ever, healthcare providers are forced to juggle these two seemingly opposed aspects of the business. Read more from this blog:

Rural Hospitals Continue to Face Healthcare Revenue Cycle Management Challenges

Rural hospitals are currently facing a unique set of healthcare revenue cycle management challenges that may force them out of business if not addressed properly. Should this happen, the country's rural population can possibly be left without any available healthcare options in their area. After all, rural hospitals are sparsely located throughout the land.

From 2010 to August 2017, a disturbing trend continues to haunt the healthcare industry. According to recent data from the University of North Carolina's G. Sheps Center for Health Services Research, as many as 80 rural hospital closed during the said period. Read more from this blog:

Thursday, August 31, 2017

Changes in the Eligibility for Medicaid May Be Underway

As more Americans are expressing a newfound public appreciation and public awareness for Medicaid, it seems like certain changes to the program, including eligibility for Medicaid are on the horizon. According to Medicaid's executive director of the National Association of Medicaid Directors Matt Salo, this is critical for the program's future. He also acknowledged that it’s now up to the states to bolster Medicaid in such a way that it becomes holistic, value-driven and most of all, better coordinated for the program's most needy beneficiaries.

Recent Attempt to Cut Medicaid Budget Failed

Recently, GOP congressional proposals have been aimed at one thing: to place a ceiling on the federal spending for Medicaid. This is intended to be part of the group's effort to overthrow the Affordable Care Act, a goal they have failed to meet yet again just recently. If they had succeeded, Medicaid would have lost as much as $834 billion in funding. Read more from this blog:

The Importance of Intimate Staff Meetings in Hospital Revenue Cycle Management

A hospital’s finance department consists of staff with various responsibilities. This means that each accounts receivable employee has different experiences and challenges in doing their work. Understanding this allows managers to focus on each individual to address issues in a way tailored to their needs to improve hospital revenue cycle management.

According to Susan Eilman, a senior healthcare consultant at Hayes Management Consulting, one-on-one meetings can be a powerful tool to increase individual productivity, creating a more efficient department. Such meetings enable hospitals to utilize listening as a tool to point out issues that may not be discovered through a larger-scale discussion. Read more from this blog:

Saturday, August 19, 2017

With Looming Budget Cuts, Getting Approved for Disability Social Security Can Become Tougher

For people living with disabilities, it’s been a case of “do you want the good news or bad news first.” Let’s begin with the good: based on several reports the lifetime of the Social Security Trust Fund has been deemed slightly healthier. This means the fund will have enough money to support the agency’s initiatives until 2028—a full five years longer than initial forecasts.

Now the bad news: the larger-than-expected fund is caused by a massive backlog in social security applications and payouts. It’s been revealed that people who have been rejected previously for disability social security benefits have to wait a record 596 days or 19.5 months before hearing anything back. This is up from 545 days in September of last year, and markedly longer than the 353 processing days in took in 2012 -- an increase of over 54%. Read more from this blog:

Tuesday, August 8, 2017

Eligibility for Social Security Disability Taking Much Longer Due to Hearings

For many people, getting social security disability benefits can be a manner of life and death. That’s why any delay in finalizing the decision is a huge cause of stress. As it turns out, hearings for eligibility for social security disability have been slowing down to a painful crawl to the point that patients in line have to wait for several more months to get a decision.

The Long Road to a Decision

It can take many months just to get a schedule for a hearing. Once the date is set, however, it’s not even guaranteed that a decision will be made immediately. The average wait for a regular disability hearing averages 19 months, while the wait for decisions to be promulgated can take anywhere from 120 to 180 days. That’s another half year of waiting, time that people with serious conditions may not be able to afford. Read more from this blog:

Monday, August 7, 2017

New GOP Proposal Raises Concerns About New Healthcare Insurance Marketplace Coverage Options

Recently, the GOP unveiled their big secret of a healthcare plan to the public. Instead of the warm welcome that they were anticipating, however, it only further stoked concern among citizens irrespective of party affiliation.

Is there cause for alarm on the GOP’s revised healthcare version, though? Here’s a closer look at what it does, and what is there to expect in the ‘Cruz Amendment.’

The Ted Cruz Amendment

In this new version, requirements for the new healthcare insurance marketplace coverage options appear to have gotten a lot less comprehensive than what is currently provided by the ACA. Here, the insurers could sell plans even if they are not all that comprehensive for as long as they also offer at least one ACA-compliant plan. Read more from this blog:

Friday, August 4, 2017

How the New GOP Proposal Can Possibly Affect Social Security Disability for Children

When the GOP unveiled their top secret Better Care Reconciliation Act in late June, which is supposedly their proud replacement for the existing Obamacare, a lot of alarm signals went off instead of celebratory ones. Most of the concerns had to do with how burdensome it’s going to be for those with the coverage, and how it essentially will leave millions without viable insurance coverage of their own.

Social Security Disability Today

One of the demographics sure to be affected are those on social security disability. The effect may not necessarily be a direct hit, but it’s there, nonetheless. It comes in the form of the removal of the Medicaid expansion, which was originally meant to cater to the needs of low-income individuals. Once this is repealed, many folks with disabilities will have difficulty finding access to proper healthcare benefits. Read more from this blog:

Wednesday, August 2, 2017

Revenue Cycle Management Services and Its Relevance for the Future

If there’s any remaining doubt as to the relevance of revenue cycle management services to healthcare institutions, new research studies showing an upward trend for the industry in the next several years ought to quell them.

According to the studies, the global healthcare RCM market is projected to grow by as much as 5% in terms of compound annual growth rate (CAGR) come 2021. Because physicians are the biggest users of RCM software, it only goes to follow that they will also be the ones benefitting the most from this development.

With the implementation of upgraded and updated RCM services, they could easily improve on their overall processes and clear their administrative tasks more efficiently. The most obvious benefit coming from all of this is a better leeway to pay more attention and provide topnotch care to their patients who matter most. Read more from this blog:

Monday, July 31, 2017

Developments on Social Security Disability Eligibility and Budget Plans

There’s been a lot of talk about Social Security as predictions and budget plans come out. For one, Social Security Administration Chief Actuary Stephen Goss claimed that the program will be able to provide full benefits to eligible recipients in the next 17 years. That’s five years longer than the fund’s solvency last year.

The increase is linked to a drop in Disability Insurance (DI) applications, which occurred after a growth caused by the economic downturn in 2008. There was a peak in applications in 2010, when the number reached 2 million compared to the 1.5 million recorded in 2007. However, the number of people applying for Disability Insurance has been declining since 2013 and the current rate is lower than the number recorded in 2007. Read more from this blog:

Friday, July 28, 2017

Disability Social Security Funds Outlook Seen as Bleak in the Coming Years

Recently, the Social Security’s board of trustees released a yearly report on the long-term financial health of its trust fund, saying that the numbers will likely drop in 17 years. These funds come from the Social Security taxes that both employers and workers pay, which are also invested and used to provide retirement, survivor and disability benefits to around 61 million Americans.

Unfortunately, disability social security is one of the programs that will be greatly affected if the gloomy prediction about the trust fund comes true. According to the report, the asset reserves of the Old-Age Survivors Insurance and Disability Insurance Trust Funds reached $2.85 trillion last year. That’s $35 billion higher than in 2016 and the figures are expected to continue increasing in the next few years. Read more from this blog:

Wednesday, July 26, 2017

Officials Looking at Ways to Stabilize Costs in the Affordable Care Act Marketplace

There’s a lot of legislative debates going on in the country these days, but there’s one thing that politicians across party lines can agree upon: universal healthcare is important. However, legislators differ on how to implement such a wide-reaching program.

Should the country’s universal healthcare system be replaced or tweaked? This is the biggest question lingering over this landmark legislation, the legacy of Former President Barack Obama.

One of the biggest challenges faced by the program today is the soaring costs of buying insurance in the Affordable Care Act marketplace in some states. While the ultimate fate of the ACA hangs in the balance, officials are trying to find ways to tweak its current shortcomings. Read more from this blog:

Monday, July 24, 2017

Despite Uncertainty in Eligibility for Medicaid, Enrollees Say They are Satisfied with Care

While there is much uncertainty regarding the future of Americans when it comes to their eligibility for Medicaid, enrollees are currently saying that they are satisfied with the care they have been receiving. In fact, they have said that they are generally satisfied with their overall experience in the program. They also said that they had been largely able to gain access to essential care.

Enrollees Currently Reporting Care Satisfaction Amid Uncertainty

The recent survey analysis was published by JAMA Internal Medicine. The data used was from the first national Medicaid Consumer Assessment of Healthcare Providers and System survey that had been administered in 46 states as well as Washington, D.C. For the study, four groups of adults who were enrolled in Medicaid were sampled. Read more from this blog:

Friday, July 21, 2017

Hospital Revenue Cycle Management Performance Can Be Improved by Looking Inwards

One healthcare executive has stated that hospitals ought to focus more on internal factors versus external ones when it comes to working on a hospital revenue cycle management turnaround. That means that healthcare executives should stop blaming market factors for their unimpressive hospital revenue cycle performance. Instead, they should turn their attention to shrinking hospital margins and lagging accounts receivable.

Per Healthcare Management Partners Managing Director Derek Pierce, if a hospital is unable to collect their cash quickly enough, it may mean that management is not focusing on the right things. That’s exactly why when certain key hospital revenue cycle performance metrics appear to be declining, Pierce advises hospital executives to turn to their internal management processes to start their turnaround. Read more from this blog:

Wednesday, July 19, 2017

The Key to Lowering Patient Cost is Value-Based Healthcare Revenue Cycle Management

A certain point has been made clear during the recent Value-Based Care Summit in Chicago by Xtelligent Media. In enabling healthcare organizations to align their healthcare revenue cycle management with value-based reimbursements, they need to start breaking down both financial and clinical siloes that have been established using the fee-for-service payment models. Moreover, everyone in each healthcare organization must learn to work together better.

According to Carmela Roberts, JD, CEO and Administrator of Valley OB-GYN Clinic in Michigan, there is a need to promote collaboration among all hospital staff, including those serving operational, financial and clinical duties. This, according to her, would be the key to developing a value cycle instead of the traditional healthcare revenue cycle.

Balancing Quality Services and Cost Efficiency

The value cycle looks to cover all the processes that can optimize financial, operational and clinical opportunities to achieve the best possible health outcomes at the lowest possible cost. As such, it would include a number of traditional revenue cycle management components, including charge capture, claims management, compliance and pricing. Read more from this blog:

Monday, July 17, 2017

What Is Revenue Cycle Management? Hospitals Seem to Fail to Capitalize on Its Benefits

Hospitals could bring in more revenue if they choose to focus on revenue cycle performance over costs. In fact, some hospitals are even showing a concerning flat performance in revenue cycle management.

According to best practices firm Advisory Board, various health systems and hospitals are missing out on a huge opportunity to increase revenue due to lagging revenue cycle performance. In fact, an average hospital with 350 beds has overlooked an opportunity to earn as much as $22 million in revenue capture, according to the firm’s analysis.

What seems to be the problem? According to National Partner for Consulting at Advisory Board James Green, a number of critical benchmarks have been continuously sliding or have remained stagnant since 2011. Because of this, Green believes that there is now a need for “strategic overhaul.” That also means meeting the four key challenges that face revenue cycle performance today. Read more from this blog:

Friday, July 14, 2017

Here’s Something That Revenue Cycle Management Companies Can Look Forward to: Good CAGR Rate

The revenue cycle management industry has a lot to look forward to. Recent data reveals that the market is set to experience significant growth by 2021. This is expected to benefit both the services and software segment.

Impressive CAGR Growth Foreseen in the Future

According to a recent study by Research N Reports, the global revenue cycle management market is expected to grow at a compound annual growth rate or CAGR of +12 percent. There is said to be a wide range of factors driving this projected growth. Among these are regulatory compliance, which encourage the use of various revenue cycle management solutions, and government support.

Meanwhile, process improvements implemented by health organizations, particularly by using revenue cycle management systems, are considered as a significant growth factor as well. Other contributing factors include the subsequent growth seen in insurance coverage as well as the increase in the number of patients. Read more from this blog:

Wednesday, July 5, 2017

Labor Force Participation Is Key Assumption Behind Proposed Disability Social Security Budget Cuts

Before he became commander-in-chief, President Donald Trump swore to his supporters that there would be no cuts to Social Security under his administration. That was then. Today, social security is facing significant budget cuts. In fact, it might not even survive during the ten years that it would gradually lose funding.

Drastic Budget Cut on Social Security Proposed Over The Next 10 Years

According to budget director Mick Mulvaney, the Trump administration is proposing a massive $72 billion spending cut on both disability social security benefits and Supplemental Security income. If approved, the said cuts would be done gradually over a span of 10 years. Previously, the Social Security Administration has already undergone a 10 percent budget cut back in 2010. Read more from this blog.

Tuesday, July 4, 2017

New Social Security Disability Eligibility Policy Makes Application Harder

Filing for social security disability is already tough in itself. With the new policies implemented by the Social Security agency recently, it’s only bound to get tougher, especially for those seeking approval for their disabilities insurance applications.

The New Policy

Just this spring, the agency announced that they will now be implementing additional safeguards to the eligibility process, specifically for the purpose of fighting fraud, as well as streamlining the application process. Among the more controversial facets of this new policy is the removal of the special consideration usually given to a patient’s long-time doctor.

The consideration came in the form of acknowledging and giving merit to the long-term relationship between patient and doctor. Under the new policy, however, the history of the patient-doctor relationship is practically dismissed and merely put in the same category or level as to that of, say, a one-time medical consultant for the patient. In order for the doctor’s history with the patient to be recognized, therefore, they now bear the burden of giving proof that their findings and opinions on the diagnosis of the patient do matter, and should, in fact, be the primary reference instead of the third-party doctor that will be provided. Read more from this blog:

Monday, July 3, 2017

Patients Are Denied Eligibility for Social Security After New Rule Imposed To Counter Fraud, Backlog

As Republicans and Democrats continue to debate the future of the social security program disability program, one thing is become strikingly clear. Many Americans are suffering as a result of long backlogs, which might consequently mean more delays for any disability case to be heard and possibly approved.

According to former Social Security Administration acting deputy commissioner Jason Fichtner, the backlog had actually started around the time of the recession. He said that at that time, a great number of people who applied for benefits were disabled. However, it did not mean that they were unable to work. Because of this trend, such a backlog has begun snowballing.

Social Security Backlog Has Caused Long Wait Times for Hearings

Today, more than a million Americans are currently waiting for their hearings. Depending on the state, waiting for a hearing may take an average of almost 600 days. On the other hand, getting a hearing is anything but reassuring for most Americans. Read more from this blog.

Saturday, July 1, 2017

Affordable Care Act Marketplace: Growing Uncertainty, Losing Providers

It’s been a rough year for Obamacare, and if the developments in Washington are any indication, it’s not going to be better anytime soon. In the past several months alone, the program has experienced a rapid decline in the number of enrollees, including dropouts.

The reason behind this is pretty obvious: the new administration had been harping on their plan to repeal and replace the Obamacare, and the Republicans in Congress did not waste any time getting to work on it. There was a snag, however, and the proposed replacements for Obamacare were not deemed good enough to pass legislation. So for now, the Obamacare act remains standing, albeit very tenuously.

Lingering Concerns

Because of these developments, insurance providers are understandably wary about continuing on with their business. As such, many of them have been closing shop, much to the dismay of their enrollees. Read more from this blog:

Thursday, June 29, 2017

Calls for Action Regarding Eligibility for Medicaid

Everyone is awaiting the Senate’s move regarding the proposed repeal of the Affordable Care Act (ACA). Earlier this year, the House of Representatives voted to replace it with a downgraded version of American Health Care Act, with the Trump administration recently revealing plans to cut budgets for Medicaid and Social Security Disability Insurance.

Whatever the Senate would approve on, however, there’s one thing that’s sure: healthcare cost is rising for states that widened their requirements for eligibility for Medicaid under the ACA. As uncertainties hover over the future of this federal-state program that was designed to provide services to low-income families, the elderly and people with disabilities, organizations are urging the authorities to protect it.

About 120 leading patient organizations wrote a letter to the Senate expressing concerns about Medicaid. They urged the Senate leadership to stop actions that would change Medicaid’s funding and stop its expansion. They want to keep Medicaid as a support line to patients with existing healthcare needs, stop the proposed switch into a per capita cap or block grant system, and maintain the program’s coverage expansion. Read more from this blog.

Tuesday, June 27, 2017

New Health Insurance Marketplace Coverage Options Possible with Proposed Bill

Uncertainties in the health insurance marketplace loom as the Trump administration reveals plans that could affect the Affordable Care Act (ACA). In line with this, some members of the Senate are hoping to establish stability by introducing the Individual Health Insurance Marketplace Improvement Act. Senators Tom Carper and Tim Kaine rolled out the bill in a bid to remove the uncertainties and stabilize the individual healthcare marketplace, as well as make premiums more affordable.

Calling for unity to improve, Carper and Kaine believe that the bill would make healthcare more affordable, accessible and stable for consumers while encouraging insurers to up their game.


Cost is one of the major hurdles in encouraging all Americans to get insurance. Low income families, in particular, would opt-out of it since they don’t have the money to pay for premiums. Even though they will save a lot by having insurance, they don’t usually have the capacity to shoulder its cost. Read more from this blog.

Sunday, June 25, 2017

Study Shows the Future of Hospital Revenue Cycle Management Looks Bright

If the projections on industry trends are to be believed, revenue cycle management (RCM) is going to experience a lot more growth and heavier demand from various healthcare institutions in the next decade. This was the finding of a recent study conducted by TMR Research concerning the relevance of global RCM in the improvement and development of industry workflow growth and development.

Increase in Demand

According to the study, increased demand will be occurring on a global scale, with developed countries in particular looking to complement the more traditional workflow models with more modern ones such as those offered by RCM services. As healthcare organizations grow over the years, the need to further streamline their workflow processes will increase, particularly in how they complete the billing cycle. After all, the bigger these organizations grow, the more complex their documentation can be. It is crucial that their medical and financial records are kept accurate for better transparency. Read more from this blog:

Thursday, June 22, 2017

Healthcare Revenue Cycle Management: A Drop in Prices, Spending and Employment

The healthcare industry saw lower numbers in the first quarter of the year. Records showed that prices, spending and employment took a fall from June 2016 to April 2017. This downward trend occurred three years after healthcare spending was accelerated.

According to statistics, healthcare prices dropped 1.9% from March to April this year. It’s only 1.6% higher than that of last year, marking the lowest annual growth rate since June 2016. Healthcare employment growth, on the other hand, fell by 10,000 per month since 2016, while healthcare spending declined by 0.5% during the same period.

These figures came amid the controversies surrounding the Trump administration’s plans to repeal Obamacare and the recent proposed budget cuts that will affect Social Security Disability Insurance. There are various reasons for the drop and slow growth in healthcare prices, spending and employment. Read more from this blog.

Tuesday, June 20, 2017

Trump’s Budget Cuts Proposal Hits Social Security Disability for Children and Adults

The Trump administration has recently unveiled a budget plan aimed at easing the country’s deficits and increasing defense funding. The plan contains budgets for several government assistance programs such as social insurance, social security, Medicare, Medicaid and food stamps.

The Social Security Disability Insurance (SSDI) will be one of the most affected programs should the budget proposal get the greenlight. This has drawn flak from a lot of people since the program covers millions of American workers, children and senior citizens. Currently, almost 9 million American workers aged between 18 and 64 are benefitting from SSDI. These beneficiaries have nearly 2 million dependents. Adult children with disabilities and widows and widowers of workers are also under this federal aid. Read more from this blog.

Sunday, June 18, 2017

What is Revenue Cycle Management Going to Be if GOP Proposal Gets Passed

After a rocky start, the GOP are once again ready to try their hand at getting their version of the healthcare bill passed. Republicans have been very secretive about the entire drafting process, working on it behind closed doors and away from the prying eyes of outsiders.

While there had been little known about what could be in the draft, the obvious anticipation is that the proposal will aim to repeal and replace significant portions of the Obamacare. The main concern of everyone awaiting this new version of the proposed bill is that it will ultimately deprive as much as 23 million people of their access to a viable healthcare system.

Worrisome Budget Cuts

In the past few months, concerns have been growing not only about the fate of the Obamacare, officially known as the Affordable Care Act, but also about the future of Medicaid and social security benefits. Read more from this blog:

Thursday, June 15, 2017

Revenue Cycle Management Companies Bracing for Significant Market Growth

The future of the healthcare revenue cycle management (HRCM) industry is bright. According to reports, the market is expected to grow significantly and hit USD 100 billion by 2024. This is thanks to the increasing use by private clinics, hospitals, diagnostics and ambulatory care centers. The development of value-based healthcare services and RCM solutions will also drive the growth, as well as increased work efficiency and quality of work life among healthcare professionals as a result of an improved level of automation.

Since HRCM is considered a vital part of the healthcare industry, this growth will benefit healthcare facilities, personnel and patients in a lot of ways. Billing processes will be made easier, thus increasing the quality of patient services and curbing down hospital expenses.

Technology and end-users are also integral in this predicted growth. Healthcare facilities are utilizing HRCM solutions to save time and money while physicians can do their jobs faster and more efficiently. Such integrated solutions prevent errors and make medical coding easier. Read more from this blog.

Tuesday, June 13, 2017

Revenue Cycle Management Services and a Decrease in Healthcare Program Enrollees

The confusion regarding the state of the country’s healthcare program continues on, and this time the effects are being more widely felt than ever. On the frontlines are healthcare providers who have reported a significant decrease in the number of enrollees over the past year.

It’s no wonder how this development came to be. With the change of administrations and a twice-failed attempt at repealing and replacing the existing Obamacare, there has been a lot of concern as to what kind of new program will be finally implemented.

Higher Risk, Low Returns

Healthcare providers are now talking about how much more difficult it is to keep the business afloat, mainly because they are not able to hit the numbers in enrollment they had been expecting. Read more from this blog:

Friday, May 26, 2017

Budget Proposal for 2018 May Cut Support for Disability Social Security

The White House is in the final stages of readying the 2018 fiscal budget that seeks to resolve the economic deficits the government is currently facing. Central to its plan of achieving this goal is making drastic cuts to mean-titled entitlement programs, such as Temporary Assistance for Needy Families, Supplemental Security Income, child nutrition programs, the Pell Grant program and food stamps.

This development comes as a surprise, especially after President Trump had made it a focal point of his campaign that he will not be cutting into these programs. While reports indicate that the budget changes will primarily be focusing on means-tested programs, there is also word that the Social Security Disability Insurance program will also be affected by these changes.

Read more from this article:

Thursday, May 25, 2017

Eligibility for Medicaid May Be Changed by the Proposed Replacement for Obamacare

Medicaid has played a big role in keeping millions of Americans adequately insured and protected with a viable health coverage. Specifically designed to make healthcare more accessible to low-income Americans, Medicaid implements a strict standard before an individual can be declared eligible for the benefits offered.

Many of the beneficiaries of Medicaid are elderly or disabled. The program’s existence is crucial to states delivering quality healthcare to their constituents. States and local governments must carefully balance their budgets to have adequate resources to allocate for this program.

Uncertain Future

Medicaid as well as the rest of the components of the Affordable Care Act (Obamacare) remains under threat of repeal and replacement. It had a very close call only recently, but the reprieve is short as another proposal has now been passed by the GOP.

Read more from this article:

Wednesday, May 24, 2017

Challenges in Healthcare Revenue Cycle Management and How Hospitals Can Weather the Storm

Last year, local hospitals reported good records despite the challenges in revenue cycle management. Increasing operating costs, regulatory issues, flat reimbursements and the switch from patient volumes to lower-paying outpatient and observation services didn’t faze many healthcare providers. Thanks to a strong stock market and lower tax-exempt bond costs, hospitals continued to do well.

While this is good news, providers can’t be complacent now with the changes and regulations awaiting the Affordable Care Act. Under the Trump administration, the U.S. House Republicans recently gave the greenlight to a bill that would revise the 2009 Obamacare. It still needs to get the approval of the Senate, but many are concerned about the impact it will have if it’s passed.

Repealing the Expansion of Medicaid

One of the major concerns is Medicaid expansion. If the bill pushes through and removes that program, it will affect people who are enrolled in it, along with the revenue of their associated hospital. St. John Providence Health System in Warren, for example, has seven hospitals and 670,000 people enrolled in Medicaid. Non-profit hospitals like these will be the hardest hit when Medicaid expansion is repealed.

Read more from this article:

Tuesday, May 23, 2017

The Digital Environment Revenue Cycle Management Companies Are Building

Major changes in revenue cycle management (RCM) technology are in store for health providers, including the small physician practice market. Currently, small medical practices are having a hard time handling the fast growth of patient payments, account management inefficiencies, and regulatory environment changes. These difficulties affect their collection of revenues, which can eventually derail the quality of services patients get when left ignored.

However, the use of electronic health records (EHR) is starting to change the landscape and improve the way healthcare organizations gather, analyze and report data. Experts believe that advanced RCM systems will keep on expanding as RCM providers work to incorporate new tools with unified platforms to enhance patient engagement, population health management and analytics. In fact, 97% of hospitals and nearly three quarters of providers are utilizing certified EHR technology.

EHR implementation poses challenges, as well, since the shift from paper to electronic records would demand a lot of time, energy and capital of a healthcare organization. These changes also call for additional training for staff involved in RCM and familiarize themselves with the ins and outs of the technology.

Read more from this article:

Monday, May 22, 2017

With Social Security in Trouble, One’s Eligibility for Social Security Disability May Become Unclear

There has been a number of discussions in Washington about the future of social security in the country. Some argue that it needs major reform. To compound matters, the sum of the President’s actions in recent months seem to imply that disability benefits and social security itself may soon be in danger.

Cost of Social Security Continues to Rise

The Social Security Disability Insurance program has continued to grow in costs over the past few years. In fact, reports estimate that it cost $143 billion back in 2015. As the costs continue to rise, officials are now saying that the disability part of the Social Security Trust Fund may well be completely exhausted by year 2022. Should this happen, benefits would automatically be cut for everyone.

In the past, lawmakers acted urgently to stabilize the disability fund. In fact, in 2015, they transferred funds from Social Security’s main trust fund to help fund disability. This time around, however, this kind of ‘fix’ may no longer work. That’s because the scenario has become more complicated than in previous years.

Read more from this article:

Friday, May 19, 2017

Social Security Disability Eligibility Faces Investigation Due to A Slew of Fraud Cases

Recently, the Social Security Administration has reportedly taken some steps to both identify and assess various fraud risks when it comes to its disability programs. According to the U.S. Government Accountability Office (GAO), the administration had managed to gather information on fraud risks during the past year, but the method had not been systematic. Moreover, the significance, likelihood and impact of all the risks identified was also not assessed. With this, hospitals and healthcare providers need to anticipate possible changes in eligibility requirements.

Fraud in Disability Has Been Going On for Some Time

During the fiscal year 2015, the payments from both Social Security Income and Disability Insurance programs amounted to approximately $200 billion. Currently, the extent of fraud across both programs are unknown.

However, several high-profile cases have made it clear that a number of individuals have managed to obtain millions of dollars in benefits fraudulently. In fact, more than 70 individuals had pled guilty to participating in a social security disability eligibility conspiracy to obtain at least $14 million in fraudulent benefits back in 2014. This is exactly why the GAO was asked to review the Social Security Administration’s fraud risk management.

Read more from this article:

Thursday, May 18, 2017

New Health Insurance Marketplace Coverage Options Get Thinner as Providers Exit ACA Marketplace

The continuing saga of the proposed changes with the Affordable Care Act is putting a lot of things in limbo, and a lot coverage providers are running for cover. Case in point, the latest company to back out of the marketplace is Aetna.

The insurer has two remaining states in their service list, namely Nebraska and Delaware, but it won’t be for long. The company has recently confirmed that they will no longer be entering back into the marketplace to sell individual health plans for the said states, a move which comes shortly after dropping Virginia from their 2018 service list.

Earlier in the year, the company had already declared that they will be letting go of Iowa. Originally, Aetna held as much as 15 states where they offered Obamacare policies. By mid-2016, however, they started to pull out from 11 of these. With the last two states now being dropped as well, it signals the official and complete exit of the insurance company from the ACA marketplace by 2018.

Read more from this article:

Wednesday, May 17, 2017

Affordable Care Act Marketplace Changes May Leave Some States Without Insurers

Over the past couple of months, insurers have been jumping ship from the Obamacare marketplace that has been under attack even more aggressively in the past year. While the changes are to be expected following the change in the administration, what remains unclear is whether or not the people relying on their ACA coverage will continue to have insurance coverage.

Coverage Woes

As it stands, there are already a lot of problems concerning the viability of the Affordable Care Act Marketplace. In certain states like Iowa, a lot of insurers have already stepped out of the picture, while others are about to ease their way to the exit. What this means is that locals are going to be hard pressed to find an alternative, or a backup plan, to keep their coverage intact for as long as possible.

In the meantime, the lawmakers are still struggling to come up with a suitable replacement that will be approved not only by the House but also by the Senate. So far, the two houses appear to be badly out of sync with each other when it comes to health care.

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Monday, May 15, 2017

A Look at the Facts on Social Security Disability for Children and Privatization

Whether you believe in privatization of social security or not, the fact remains that it would cause significant changes within the revenue cycle management industry. The general public don’t hold out much hope when it comes to receiving benefits from the program. In fact, only 37% of those questioned believe somewhat that the social security system will benefit those in the future as much as it does today.

What does a privatized social security system look like, and how will this affect social security disability for children and countrywide revenue cycle management processes?

How is Social Security Being Privatized?

The general idea for a privatized social security system is that instead of paying taxes and ultimately receiving benefits in the future, people will make monetary contributions to their own privately managed savings accounts.

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Friday, May 12, 2017

Employ More Assistants to Improve Hospital Revenue Cycle Management Processes

Recent years have seen numerous changes headed towards hospital revenue cycle management processes, including the introduction of ICD-10 and changes to Medicaid and Obamacare. Because of this, healthcare facilities need to become more creative in how they manage these issues while still maintaining focus on keeping costs low.

Although it may initially seem counterproductive, the truth may be that increasing the amount of assistants employed across the hospital setting may be the answer to streamlining revenue cycle management processes.

Keep Billing Specialists Focused on Their Role

If your healthcare facility expects billing specialists to speak to patients about denied claims, outstanding balances and collect the copay, you may need to rethink this model. Instead of using the costly time of specialists for these matters, leave them to focus on completing coding on patient documents instead.

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Wednesday, May 10, 2017

The Advent of Online Billing Portals Spurs Revenue Cycle Management Services to Adjust

How familiar is your health care facility with the primitive payment options available to patients? If you only have a simple username and password system for a third party payment site, you’re already behind the times when it comes to new technologies that streamline revenue cycle management services.

Recent evidence reveals concerning trends in healthcare collections. Patients are now expected to assume more responsibility for the cost of their health care, which means hospitals are required to be much more upfront about the portion of the bill each person is expected to pay. While patient satisfaction may increase, many bills might go unpaid and healthcare facilities might begin to suffer if suitable processes aren’t in place to collect these payments.

Some Background on Online Payments

Due to concerns over patient confidentiality, online payment methods inherently involve complex or hardly simple procedures. A common method involves an online form completed by patients who convey their payment details on the form. The snarl in this method develops when a revenue cycle management worker must then re-enter these details to manually process the payment.

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Monday, May 8, 2017

What is Revenue Cycle Management Going to Look Like with Increased Consolidation?

Today’s news stream brims with discussions around the increased levels of consolidation in the U.S. healthcare industry. Meanwhile, many healthcare providers are now asking, “What is revenue cycle management going to look like with a rise in consolidation?”

To understand any coming changes, the recent trends in consolidation need to be examined carefully by providers and their revenue cycle management companies.

The Shift to Value Based Care

National healthcare expenditures continue to rise, currently at a level of 18%, compared to only 12.5% in 1990. The onus now rests on healthcare facilities to find a way to combat this rise. Generally, they are countering with significant consolidation of services.

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Wednesday, April 26, 2017

Social Security Disability Eligibility Cuts Treating-Physician Rule, Keeps Appeal Waiting Times Long

The Social Security Disability program benefits millions of Americans, no matter how old or young they are. However, a new rule imposed by Social Security recently may make it harder for any patient of any age to be approved for social security disability eligibility. This is because the administration has recently introduced a new rule where doctors’ reports would no longer be used to determine an individual’s eligibility to receive benefits.

Rule changes such as this present additional challenges to hospitals and healthcare institutions trying to determine if their patients qualify for disability benefits.

Social Security Administration Announces an Update to Its “Treating-Physician Rule”

The Social Security Administration has just said that it will now eliminate the use of what is known as the “treating-physician rule” as a basis of disability eligibility. The said rule refers to Social Security’s previous practice of giving a doctor’s report significant weight in supporting a person’s disability entitlement. Previously, Social Security adjudicators are required to consider evidence of disability as presented by the medical professional treating the claimant.

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Monday, April 24, 2017

New Bill Offers Disability Social Security Beneficiaries a Pathway Back to the Workforce

Americans who are on disability social security may soon find themselves back to work the moment they are able to. A new proposed bill in Congress aims to give recovering beneficiaries a pathway back to the workforce. This would give them the chance to start their life over after going through a series of medical treatments and recovery.

Earlier this year, Rep. French Hill, R-Ark. had introduced the Social Security Disability Insurance Return to Work Act of 2017 in the House of Representatives. On the other hand, Senators Tom Cotton, R-Ark.; Mike Lee, R-Utah; and Marco Rubio, R-Fla. introduced a companion bill in the Senate.

Hospitals and healthcare facilities need to be aware of these proposed changes so they can properly assess their patients’ eligibility for the program.

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Sunday, April 23, 2017

Why Eligibility for Social Security Disability Remains a Challenge for Some

The difficult process of filing for benefits is causing the social security disability program to fail many of the people it’s supposed to serve. A combination of administrative inadequacy and far too rigorous requirements have only managed to deny benefits to some deserving claimants. This provides hospitals and healthcare institutions with an opportunity to improve their revenue cycle management processes by helping their patients with SSDI eligibility problems.

Background on SSDI

The social security disability program was created to help people who are unable to work due to a disability. In the event that able-bodied individuals suddenly become injured or fall ill, they can have some financial relief to look forward to.

These benefits are also extended to children who suffer from disabilities or conditions that prevent them from fully functioning. The extension of the benefits to disabled children is meant to relieve parents of the cost of providing for whatever special needs they may have.

This, however remains to be only an ideal for some people. In fact, even if they have been religiously contributing, they may still find it difficult to meet the requirements for eligibility for social security disability. Read more on this article:

Friday, April 21, 2017

The Affordable Care Act Marketplace Is Under Threat as Insurers Stand to Lose Federal Subsidies

All over America, uncertainty continues to loom when it comes to the future of healthcare insurance. In recent months, the Republican party has worked hard to repeal and replace the Affordable Care Act or Obamacare. Their version of Obamacare, dubbed as the American Health Care Act, presented challenges to both individuals and healthcare facilities with possible changes with their health plans.

However, this attempt failed to secure enough votes to introduce a new healthcare system being supported by President Donald Trump and several members of the Republican party. Following this, President Trump said that the Affordable Care Act would stay in place in the meantime as the GOP carefully plans how best to approach the overhaul of the U.S. healthcare system.

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Wednesday, April 19, 2017

Work Requirement May Soon Help Determine Eligibility for Medicaid Benefits

For quite some time now, Medicaid has been the most widely available source of health coverage for people living across the United States. Through this program, over 72.5 million Americans, particularly disabled individuals, pregnant women, children, and seniors, were able to gain affordable health coverage. Due to recent events, however, many of them are at risk of not being able to avail of Medicaid when they would need it most.

After the recent collapse of the proposed American Health Care Act or AHCA, there has been increased interest among the Republicans to add work requirement into the eligibility for Medicaid. In fact, Department of Health and Human Services Secretary Tom Price and Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma both sent letters to various state governors, giving them greater flexibility when it comes to approving Medicaid Section 1115 waivers. At the same time, these include a number of work-related proposals. 

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Tuesday, April 18, 2017

CMS Looking at New Health Insurance Marketplace Coverage Options by 2018

Even as the Affordable Care Act (ACA), otherwise known as Obamacare, survives to live another day, the seeds of doubt have already been planted in the minds of the insurers. Is it on its way to a more sustainable future, or is this but a temporary reprieve from the threat of repeal and removal?

Waiting in the Dark

For most health insurers, it’s a lot like a waiting game--and in the dark, too. The new administration had been very vocal about providing a new model for the health insurance marketplace, but this confidence was doused by failure to gain approval from Congress. As a result, many of the providers are choosing to tread lightly, opting not to commit fully about staying on in the program, at least until the new administration does offer a clearer stand about what it intends to do about healthcare policies. Read more on this article: