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: http://bit.ly/2yaKms3

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: http://bit.ly/2wO6Miv

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: http://bit.ly/2ycHbjE

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: http://bit.ly/2xR3ieq

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: http://bit.ly/2xRflYW

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: http://bit.ly/2yaAIW7

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: http://bit.ly/2wOj5eD

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: http://bit.ly/2vbey6Y

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: http://bit.ly/2wl1vOC

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: http://bit.ly/2vail47

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: http://bit.ly/2qiK9yr

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: http://bit.ly/2rCePij

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: http://bit.ly/2qiL4ik

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.

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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: http://bit.ly/2rfos6I

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: http://bit.ly/2rOra04

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.

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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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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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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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