62 Hospitals Sued for Fraudulent Patient EHRs and Falsified Claims

December 1, 2017 / 0 Comments

EHR Intelligence reports on a whopping sixty-two Indiana hospitals being sued in a federal civil lawsuit for allegedly falsifying records and participating in a kickback scheme, primarily by overbilling for the release of patient Electronic Health Records. As reported in The South Bend Tribune: Memorial Hospital of South Bend, Saint Joseph Regional Medical Center in Mishawaka,…

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CPAP Denials Are A Bigger Deal Than You Thought.

November 28, 2017 / 0 Comments

Earlier this year, The Huffington Post reported on the largely negative impact Medicare regulations are having on CPAP users and providers. On the provider side specifically, CPAP denials have been known to top denials lists for HME and DME suppliers, meaning that understanding the layers of Medicare’s logic is the first step in understanding how…

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Are You Analyzing Your DME/HME Claims Denials?

November 22, 2017 / 0 Comments

The CHANGE HEALTHCARE HEALTHY HOSPITAL REVENUE CYCLE INDEX estimates that out of the $3 trillion in claims that were submitted in 2016, 9 percent ($262 billion in charges) were initially denied. For your average health system, that adds up to as much as 3.3 percent of NPR, dinging them for an average of $4.9 million…

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RCM Needs To Accept Millennials

November 21, 2017 / 0 Comments

Becker’s ASC Review reports that Millennials, or individuals born roughly between 1980 and 2000, now number 73 million in the United States (according to the polling firm Gallup). They are well on pace to soon outnumber Generation X — their immediate predecessors — at all U.S. companies. For review, here’s a timeline (just one of many…

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Newsflash: 90 Percent Jump in Uncollectable Denials in Just 6 Years

November 17, 2017 / 0 Comments

It looks like 2018 is going to be the year of denials and that’s exactly as foreboding as it sounds. Becker’s article based on the Advisory Board’s survey revealed that denials written-off as uncollectable, costs the average 350-bed hospital $3.5 million annually; a whopping 90 percent jump from just six years prior. Compounding this challenge…

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7 Strategies to Prevent Claims Denials

November 16, 2017 / 0 Comments

We operate in an already complicated reimbursements environment, so anything we can do to minimize the constant threat of denials is going to help the entire revenue cycle. Becker’s Hospital Review produced a helpful webinar discussing strategies to prevent claims denials that can be accessed here. In an article summing up the presentation, Becker’s distills…

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Fee-For-Service Healthcare Payments – Shrinking

November 9, 2017 / 0 Comments

An article on the HealthExec website describes a Health Care Payment Learning and Action Network (LAN) report recently released, showing that 43 percent of payments to health systems came from traditional fee-for-service (FFS) payment models in 2016. That’s down from 62 percent the year before. Meanwhile, alternative payment models’ (APMs) share increased from 23 percent to 29 percent. While…

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Selling a Latte For $5; Collecting Only 50¢ at Time of Purchase …

November 6, 2017 / 0 Comments

Sometimes it’s instructive to remind ourselves just how “different” the world of health care payments can be. Consider Dr. Andrew L. Pecora’s Starbucks metaphor in an article entitled The Quirky Way Physicians Are Paid: Imagine a hypothetical board meeting at Starbucks Corporation where a newly hired CEO tells the board how he intends to increase same-store…

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Feel the Pain: Paper Is Hurting All Healthcare Stakeholders

October 26, 2017 / 0 Comments

The Trends in Healthcare Payments Seventh Annual Report: 2016, available for free download – offers a look at how delaying the inevitable electronification of payments at all levels of healthcare transactions is costly on many levels to healthcare providers. Consider the following facts from a post at at AJMC: 88% of providers reported that they received…

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Becker “Power Panel” Makes 5 Key Observations on Managing RCM

October 19, 2017 / 0 Comments

Attendees at the Becker’s Hospital Review 3rd Annual Health IT + Revenue Cycle Conference in Chicago were treated to a panel of healthcare heavyweights discussing revenue cycle performance. The distinguished group included Vice President of Revenue Cycle Management at San Diego-based Sharp HealthCare Gerilynn Sevenikar; Vice President of Product Management and Revenue Cycle Analytics at…

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