Hayes' Healthcare Blog

4 KPI Focus Areas to Ensure Revenue Integrity

Posted by Sondra Akrin on September 27, 2017 at 9:00 AM

Maintaining your revenue integrity in a time of reduced revenue and shrinking margins has never been more important – or difficult. New reimbursement models, the cost shift to patients, a substantial increase in auditing from a greater number of agencies and continued merger and acquisition activities combine to put enormous stress on the financial condition of healthcare organizations.

Like most other things in business, ensuring revenue integrity comes down to managing the details. Monitoring and measuring day-to-day activity can be the best way to make sure your revenue cycle is operating smoothly and you are identifying, billing and collecting all the revenue you should be.

Developing appropriate Key Performance Indicators (KPI’s) can help guide the daily activities in your organization and keep your revenue cycle on track. Diligently monitoring KPI’s to improve performance becomes a critical task to helping you maintain your revenue integrity.

Here are four key areas on which to focus your KPI efforts.

Read More

Topics: revenue cycle management, Revenue Cycle Health

Restoring the Joy in Clinical Practice

Posted by John Halamka on September 20, 2017 at 9:00 AM

By Dr. John D. Halamka, MD, MS, CIO of Beth Israel Deaconess Medical Center

The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 has been blamed for many things, including the diminished joy of clinical practice.  

While HITECH certainly has its flaws, it’s hard to deny the positive impact.  In 2008 before the act was passed, less than 10 percent of non-Federal acute care hospitals were using a basic EHR. In 2015, 96 percent of those same organizations had implemented a certified EHR system. No other sector of the U. S. economy has experienced such accelerated technology adoption.

However, HITECH is just one component of the legislation, regulations and demands that have increased practice burden without simplifying processes through automation.

What can we do to transform the EHR from a burdensome requirement into an essential tool that improves the quality of practice life? Ideally the EHR of the near future will integrate patient data from multiple sources - providers, payers, patients, employers and devices then turn that data into wisdom, providing the clinician with actionable advice that will improve quality and reduce total medical expense. To realize that goal there is foundational infrastructure to be built. Instead of wringing our hands and blaming “information blocking”, we should focus on a short term work plan with the following.

Read More

Topics: clinical optimization, EHR, value-based care, Hayes Thought Leadership Blog Series, HITECH

Developing the ROI for Your Business Office Consolidation: 5 Key Questions

Posted by Revenue Cycle Transformation Team on September 13, 2017 at 9:00 AM

Merger and acquisition activity, the demand for cost reduction, and the need for better efficiencies have forced many healthcare organizations to implement a business office consolidation. While this may appear to be a logical step to meet the budgetary challenges facing hospitals and physician practices, you will still likely need to justify the disruption and expense of implementing the project. Before taking the plunge, you will need to calculate the ROI for the move.

Here are five questions to ask to help you develop the ROI for your business office consolidation project.

Read More

Topics: revenue cycle management, revenue integrity

3 Benefits of a Data Driven Approach to Billing Integrity

Posted by Robert Freedman on September 6, 2017 at 9:00 AM

Six trends affecting the healthcare billing industry in 2017 have been identified by MedicalBillersandCoders.com. They include the transition from ICD-9 to ICD-10, implementation of CPT codes, evolution of EHR management, the rise of money managers, cognitive computing and onset of block chain technology.[1]

As the healthcare industry continues to evolve, more focus is being placed on revenue integrity. This means more intense scrutiny on every element of the revenue cycle from the front end through the mid-cycle to the back office. No aspect of the revenue cycle is receiving more attention than the billing function.

Organizations must deal with these trends while at the same time ensuring the quality of their billing function. Many rely on auditing to monitor their billing processes and make sure billing departments are being run effectively. However, the key to proper billing is identifying root cause issues and applying appropriate corrective action. Auditing is simply a tool to help accomplish that, not an end in itself.

To ensure billing integrity, organizations must develop a process that is supported by a system. Auditing is only one element of an oversight system that also includes analysis and corrective action. Taken together, this system supports a data-driven approach that can enhance billing integrity. The system should effectively translate patient encounters into proper coding to ensure full payment and maintain compliance – making sure you get to keep what you have collected.

The system ultimately needs to be driven by data, since data gives you analysis that provides insight necessary to implement improvement. Here are three key benefits of a data-driven approach to ensuring billing integrity.

Read More

Topics: compliance risk, mdaudit, Revenue Cycle Health, revenue integrity

Want more from Hayes?

5 Cool Things in Healthcare

Sign up for our weekly 5 Cool Things in Healthcare newsletter.  Every Friday we give you five stories of innovation, disruption, and - you guessed it - coolness. 

Here's how:

Subscribe to Email Updates

Recent Posts

Posts by Topic

see all