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.
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,
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.
In continuation of our previous article on the Benefit and Payment Parameters for 2017, given below are further highlights of some of the policies in the final rule.
Student Health Insurance Plans
Risk pool must be based on bona fide school related classification and not on health status if issuers of student health insurance plans wish to establish one or more separate risk pools for each individual college or university.
Released on February 29, 2016, the final Health and Human Services (HHS) Notice of Benefit and Payment Parameters for 2017, sets standards for Health Insurance issuers and marketplaces which includes payment parameters, establishes new standards for improving consumers’ marketplace experience, promote continuity and stability in the marketplaces and ensures affordable and accessible coverage.
The ever-changing healthcare scenario is making it difficult for clinicians to manage their finances. On one hand, the number of patients are increasing every day, while on the other, reimbursement by insurance companies for medical care provided is being reduced. Rising expenses and tons of paperwork; compliance issues and fears of a malpractice suit – all these are creating pressures on healthcare providers to maintain their standards of care and service.
The biggest problem in revenue cycle management for healthcare facilities is unpaid bills for medical services provided. The acquisition of medical debt leads to a detrimental impact on medical care provided by the healthcare facility and negatively affects the healthcare industry in general. There is a dire need to redesign the medical billing system to ensure shrinkage of bad debts,