Managing your healthcare revenue cycle is never easy. Revenue leaks can create havoc with your organizations financial viability. The root cause of revenue leaks are generally internal, with someone in the system or the system itself, not performing correctly or efficiently. According to Marc Lion, CEO of Lion & Company CPAs, the average medical practice has a 10 to 15 percent profit leak.
Once an informal process that received significant attention at just a few hospitals; Clinical Documentation Improvement (CDI) is now the backbone of an organizations financial viability. Essential for patient safety, proper and accurate reimbursement, quality ratings and more, a strong CDI program will ensure documentation integrity – a key factor in the ICD-10 transition.
Drug addiction – a problem that most governments across the world are fighting to control, has not only become a major cause of death for the addicts, but is also responsible for neonatal abstinence syndrome amongst newborn children of addicts. There are many ways in which people get addicted to drugs like opium and heroin.
The main reason for the transition from ICD-9 to ICD-10 was greater documentation precision. However, if the diagnostics is documented by clinicians at a lower level than what ICD-10 supports, it may result in submission of financial claims that are lower. Such documentation will also cause a patient’s medical record to lack details, resulting in incomplete information for future providers.
One of the key components for healthcare providers and facilities, healthcare revenue cycle management can be intimidating and confusing for a lot of people. Statutory requirements, coding and billing, payments and denials – add to these the various terms and acronyms that are used – and you have a mine-field on your hands.
Hiring incompetent healthcare providers or allowing them to remain with your facility can lead to increased liabilities in malpractice suits. In order to ensure that your facility does not suffer from this, it is important that credentialing and enrollment of your providers is managed properly and kept up to date. Failure to do so can and will have a negative impact on your revenue cycle.
Healthcare facilities address the health needs of people and are supposed to treat the sick under all circumstances. However, for any organization to remain viable and continue to provide services, it needs to be paid for the services provided – fully and in time. In order to receive their just dues, organizations have to work with various payers,
Medicare enrollment can be very confusing for those enrolling for the first time. From being aware of the enrollment period to understanding the type of health coverage required; from finding out the various options available to being knowledgeable of the various scams related to Medicare – all this can cause stress and confusion. Choosing the right plan requires an individual assessment.
As per Section 6401 (a) of the Affordable Care Act, all enrolled providers and suppliers are required to revalidate their Medicare enrollment information under the new enrollment screening criteria.
The Revalidation Process
- Determine which provider is being requested to revalidate
- View the information checklist
- Revalidate using Internet-based PECOS or by completing the appropriate CMS-855 application
- Check your application status
PECOS is the most efficient way to submit your revalidation information.
Our final article on the Benefit and Payment Parameters for 2017 brings you further highlights of some of the policies in the final rule.
Network Adequacy (Transparency)
HealthCare.gov plans to include a rating of each QHP’s relative network coverage, with a goal to start this inclusion in 2017.