Hayes' Healthcare Blog

Improving your Clean Claim Rate: 5 Areas to Focus On

Posted by Dion Giordano on November 29, 2017 at 9:00 AM

With today’s ever-increasing squeeze on healthcare organizations’ bottom lines, the quality and performance of a billing department is vital to its operating margin. What’s more, the billing department’s clean claim rate is a critical factor to help achieve budgeted operating margins. 

A clean claim is a claim that was accurately processed and reimbursed the first time it was submitted to the payer, without error, rejection, and manual intervention. Industry best practice for first pass clean claim rate is 90% or above which can be understandably difficult considering how many claims an organization processes everyday but not impossible if the billing department is optimized.

Here are some areas of your billing department you should examine when wanting to improve your organization’s clean claim rate. These will not only make your processes more efficient but also ensure your organization hits the best practice percentages that ultimately help your bottom line.

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Topics: decreasing claims denials, healthcare revenue cycle improvement, revenue cycle

Happy Thanksgiving from Hayes

Posted by Admin on November 22, 2017 at 9:00 AM

During the holiday season, Hayes would like to give thanks to all of our clients, followers, colleagues, and friends for your continued support. We wish you a wonderful holiday with your family, friends and loved ones. 

Make sure to check back next week for our regularly scheduled blog.

Have a happy Thanksgiving!

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Topics: holiday, thanksgiving

5 Ways to Avoid Analysis Paralysis on your next Revenue Cycle Project

Posted by Tamarah Alexander on November 15, 2017 at 9:00 AM

We’ve all heard the expression, “Rip off the Band-Aid” and yet it still makes us flinch.   It is human nature to recall previous effects associated with a painful or hard decision.  Often times, we are left with the sting of the decision long after the proverbial Band-Aid has been ripped off and other times we sigh with relief and think, “that wasn’t so bad after all!” 

The healthcare revenue cycle of today is continuously changing and it requires a lot of heavy lifting to ensure the changes required are managed in our electronic databases are well communicated to staff and, most importantly, have minimal impact on the patient’s overall experience.  During times of great change, operations and technology will encounter circumstances that will require a lot of careful thought and analysis to deliver the best possible solutions where time is also of the essence.  So how do you balance an optimal delivery of high quality work within an acceptable time frame? 

Following these five tips will allow you to understand, mitigate and weigh your options without the dreaded presence of Analysis Paralysis.

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Topics: heatlhcare revenue cycle optimization, healthcare project management

Are You Ready for Revenue Cycle Consolidation? A 7 Point Checklist

Posted by Sondra Akrin on November 8, 2017 at 9:00 AM

As the pressure on top and bottom lines grows, many healthcare organizations are focusing on revenue integrity as a way to improve margins. Part of this effort requires lowering overhead costs by driving efficiencies into their revenue cycle operations. These streamlining projects include consolidating business office functions to minimize duplication of effort around registration, insurance assignment and verification and customer service on both the physician and hospital sides of the organization.

An increase in merger and acquisition activity continues in the healthcare industry and this, too, can cause the need for a business office consolidation. 

Whether driven by a cost cutting initiative or merger, the consolidation initiative means merging the entire revenue cycle. Combining tasks, workflows and technology to create economies of scale can result in significant cost savings.

Centralizing business office functions can be challenging. Before you attempt to take on such an ambitious project, you must be sure your organization can carry it out successfully. You need to understand the inherent differences between the organizations or divisions you plan to consolidate. You should start with a comprehensive assessment of your people, process and technology to provide a baseline from which to proceed with the project.

This seven-point checklist will help you determine your readiness and will guide you in focusing on the areas you should be addressing as you begin your consolidation.

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Topics: healthcare mergers and acquisitions, Revenue Cycle Health

Seeing the Light on Risk-Based Auditing: A Real-World Example

Posted by Robert Freedman on November 1, 2017 at 9:00 AM

The Aha Moment. Seeing the Light. The Eureka Effect.  These are all terms for the same human experience: suddenly understanding a previously difficult to understand concept.

We’ve been speaking a great deal lately about the benefits of risk-based auditing versus traditional, periodic auditing. We’ve outlined the benefits and encouraged you to consider making this switch to better meet your compliance and revenue integrity goals. This is all beneficial information that can help you make difficult decisions.

But even more powerful than theory is actual practice. In a recent discussion with a senior audit leader, I witnessed an “Aha Moment” first hand. After laying out the advantages of risk-based auditing, I watched as he suddenly understood what I was talking about. The clouds parted and he saw the light. He is now a passionate advocate for risk-based auditing.

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Topics: Risk-based audits

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