CFO & COO Share Two Critical Revenue Cycle Management Lessons

Heather Chartier, MS, RHIA, CCA Revenue Cycle Leave a Comment

Leaders at Carolina Community Health share their experiences on outsourcing revenue cycle management processes to ensure the success of the organization.   Among the top concerns for chief financial officers (CFOs) and vice presidents (VPs) of revenue cycle these days are labor shortages, increasing costs, insufficient capacity causing care delays, and recession....

4 Charge Capture Process Approaches & Reasons for Inaccuracies

Heather Chartier, MS, RHIA, CCA Auditing Leave a Comment

Proper charge capture processes are essential to compliance regulations. An outdated, non-existent, or poorly thought-out charge capture workflow can be devastating to a hospital and healthcare system’s bottom line. Overcharging can be just as harmful as undercharging for medical services. The key to appropriate charge capture processes has shifted from a solely...

5 Pieces of Advice for New H.I.M. Directors

Heather Chartier, MS, RHIA, CCA Revenue Cycle Leave a Comment

Finding purpose through meaningful work has been on the minds of many lately. Purpose, essential to organizational development and the lifeblood of the human heart as it relates to the whole organizational body system, is what makes life meaningful. Often, health care workers enter the health care field because they love to help people and contribute to enhancing a...

Retirement Looms for 3.5 Million Retirees; How H.I.M. Directors deal?

Heather Chartier, MS, RHIA, CCA Revenue Cycle Leave a Comment

According to a Pew Research Center analysis, retirement looms for 3.5 million retirees over the next year, including the most recent labor force data.1 Many organizations face this worrisome predicament, yet many health information management departments struggle with being proactive in their planning efforts. This week's blog post asked three healthcare industry leaders...

OPPS FY2022 Final Rule - Overview

Gloryanne Bryant, RHIA, CDIP, CCS, CCDS Revenue Cycle Leave a Comment

The Hospital Outpatient Prospective Payment System (OPPS) Final Rule for Fiscal Year 2022 has been released by the Centers for Medicare and Medicaid Services (CMS). Included in the 1394 page OPPS final rule announcement that came on 11/2/2021 was the 2022 payment policy for Ambulatory Surgery Centers (ASCs) which is available at: ...

7 Points of Focus When Your Revenue Cycle Metric is Low

Heather Chartier, MS, RHIA, CCA Revenue Cycle Leave a Comment

Metrics represent values to measure an organization’s strategy. Leaders should understand that metrics cannot replace strategy. It can lead to behaviors that undermine the very strategy the metrics expect to measure, resulting in negative consequences for all. Remember the severe negative repercussions the banking giant, Wells Fargo experienced when it aggressively pushed...

CMS MA Star Ratings…..What are they?

Gloryanne Bryant, RHIA, CDIP, CCS, CCDS Revenue Cycle Leave a Comment

Across the Medicare Advantage (MA) Risk Adjustment (RA) healthcare world, we often hear about “Star Ratings.” With the October MA Star Ratings being released by the Centers for Medicare and Medicaid Services (CMS) a common question is: What are the CMS Star Ratings? CMS publishes the Medicare Part C and Part D Star Ratings each year to measure the quality of health and...

CMS Hospital Readmission Program: Penalties Announced

Gloryanne Bryant, RHIA, CDIP, CCS, CCDS Revenue Cycle Leave a Comment

Back in October 2012 (which is fiscal year 2013) the Hospital Readmission Reduction Program or HRRP was started in accordance with Section 1886(q) of the Social Security Act. This regulation set forth the statutory requirements for HRRP, which required the U.S. Department of Health and Human Services (HHS) via the Centers for Medicare and Medicaid Services (CMS) to reduce...

Considering Outsourced Services? Choose Wisely

Heather Chartier, MS, RHIA, CCA Revenue Cycle Leave a Comment

Summary   As the world of healthcare becomes more complex, healthcare executives are searching for ways to curb costs quickly and substantially while remaining competitive and profitable. Outsourcing is one way to reduce inefficiencies and eliminate redundancy. Let's explore some of the pain points health systems and hospitals face along with the pros and cons of using...

CMS Compliance Reminder and 3-Day Window Rule

Gloryanne Bryant, RHIA, CDIP, CCS, CCDS Revenue Cycle Leave a Comment

The Centers for Medicare and Medicaid Services (CMS) released a compliance reminder regarding, “Non-Physician Outpatient Services Provided Before or During Inpatient Stays: Bill Correctly” in their October 14th, 2021, Medicare Learning Network (MLN) news. Understanding this particular CMS policy, one needs to review the language: Medicare’s 3-day (or 1-day) payment window...

OIG Reports Medicare Overpaid Neurostimulator Implantation Surgeries $636 Million

Gloryanne Bryant, RHIA, CDIP, CCS, CCDS Revenue Cycle Leave a Comment

On October 1st, 2021, a report from the Office of Inspector General (OIG) was released regarding the Centers for Medicare and Medicaid Services (CMS) coverage violation of insertion or replacement of Neurostimulator Implantation surgeries. CMS had performed an analysis of prior Part B claims data and identified concerns and thus directed a supplemental post-payment...

Medicare and Medicaid Recovery Audit Contractors... Continue Their Efforts

Gloryanne Bryant, RHIA, CDIP, CCS, CCDS Auditing Leave a Comment

Protecting the Medicare Trust Fund is an important priority for the Department of Health and Human Services (HHS) Centers for Medicare and Medicaid Services (CMS), the Office of Inspector General and thus we have Recovery Audit Contractors or “RACs”. Through the Medicare Modernization Act of 2003, CMS established the Recovery Audit Contractor program with a focus on...

The FY2022 Proposed Inpatient Prospective Payment System (IPPS) Rule Is Released

Gloryanne Bryant, RHIA, CDIP, CCS, CCDS Revenue Cycle Leave a Comment

With the last 14 months being impacted by the COVID-19 public health emergency (PHE), we experienced significant changes and revisions to policies across the continuum of healthcare. It’s time once again for the Inpatient Prospective Payment System (IPPS) proposed rule for the coming fiscal year 2022 (FY2022). Here are “some” highlights from the CMS proposed IPPS rule: ...

Repost: Where’s the Value? Six reasons why healthcare payment reform has stalled.

Stephanie Kovalick Revenue Cycle Leave a Comment

And What the Future Might Hold By Stephanie Kovalick  For years, healthcare industry pundits have been predicting that we’re on the verge of a tipping point in value-based payment (VBP) and/or care. In a 2016 survey of 115 payers by ORC International and commissioned by McKesson, respondents predicted that VBP—such as pay-for-performance, global payment or capitation,...

Get Your PEPPER . . . MS-DRG Data and More

Gloryanne Bryant, RHIA, CDIP, CCS, CCDS Revenue Cycle Leave a Comment

The Program for Evaluating Payment Patterns Electronic Report (PEPPER) was developed in 2002 by TMF Health Quality Institute in support of CMS’ Hospital Payment Monitoring Program. State Quality Improvement Organizations (QIOs) began distributing PEPPER to the short-term acute care hospitals in their state in 2003. PEPPER provides provider-specific Medicare data...

Medicare/Medicaid Underpayments a 75 Billion $ Reality per AHA Report

Gloryanne Bryant, RHIA, CDIP, CCS, CCDS Revenue Cycle Leave a Comment

Across healthcare we focus on patient care and outcomes which is primary and foremost. In addition, we also focus on revenue and the revenue cycle. This will mean overpayments, which are compliance and financial risks and underpayments which are also both a compliance and financial risk. The American Hospital Association (AHA) released in January their annual report and a...

OIG Report Regarding CERT Not Being Use by CMS and Contractors 1/2021

Gloryanne Bryant, RHIA, CDIP, CCS, CCDS Revenue Cycle Leave a Comment

A new OIG (Office of Inspector General) report has been released that is important to review. The title is: CMS and Its Contractors Did Not Use Comprehensive Error Rate Testing (CERT) Program Data To Identify and Focus on Error-Prone Providers (A-05-17-00023). See the OIG summary information below:    OIG Report: CMS and Its Contractors Did Not Use Comprehensive Error...

HIM Outsourcing—When is it a Good Idea?

Charlie Saponaro - CEO Revenue Cycle 1 Comment

HIM Outsourcing Our industry’s transition to EHRs has opened new doors for health information management (HIM). HIM’s operational areas have become more specialized than ever. The result? Many healthcare executives are now able to reduce expenses, reallocate staff and free up space through centralization and remote workers. According to a recent HealthLeaders CFO Forum,...

HIM Shifts Ahead: 3 Trends for Revenue Cycle to Know

Charlie Saponaro - CEO AHIMA Leave a Comment

The shift in roles, responsibilities and reporting structures for Health Information Management (HIM) professionals is top of mind for healthcare revenue cycle and finance executives as we enter 2015. What lies ahead for HIM and their relationship to revenue cycle? Here are three trends for healthcare finance executives to consider. 1. Shift Coding to Revenue Cycle /...

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