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Healthcare Revenue Cycle Management

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Root Cause Analysis Is the Foundation to Denied Claim Analysis

December 27, 2017

Of course, the best way to handle claim denials is to prevent them in the first place. That’s why this recent list of denial prevention strategies from Becker’s is something no denial manager should miss. We believe though that it has a problem. Boiling down denials to a list like this obscures the fact that…

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These “Far-Out” Denials Can Cause Real Audit Problems

December 21, 2017

You might have heard of some of these “far-out” denials from an HME NewsPoll, but they really are worth a review… …a Medicare prescription denied because it was “written by a girl.” …an agency had a beneficiary “listed as dead, then alive, then dead again.” …multiple providers receiving denials for wheelchairs intended for amputees and…

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ONC and Innovation

December 20, 2017

The 2017 ONC Annual Meeting, held November 30th to December 1st in Washington DC, was all about healthcare interoperability and health IT usability this year. The Office of the National Coordinator for Health Information Technology (ONC) is organizationally located within the Office of the Secretary for the U.S. Department of Health and Human Services (HHS) and leads the…

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Find Out Where You Stand Today on This Controversial DME Prior Authorization Rule

December 14, 2017

Becker’s announcement on CMS’ DME prior authorization rule came a while back, but CMS’ stance on prior authorization is likely still causing denial issues for your facility today. The Backstory Just as 2016 was about to round the corner, CMS issued a rule requiring prior authorization before Medicare would reimburse DME that had been found…

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A Revenue Cycle Turnaround Case Study

December 14, 2017

We recommend you buy a Starbucks coffee and set aside an hour to watch the “Coffee With Coker” presentation entitled “Revenue Cycle Turnaround: Rebuilding for an Advanced ROI – A Case Study,” which is archived here. Senior Vice President of Coker Group Jeff Gorke takes us through the components and challenges of building and maintaining…

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Telemedicine’s Newest Threat. DME Denials?

December 6, 2017

A recent report from Grand View Research reveals a potentially hidden threat to telemedicine programs. We’re all aware that chronic disease is a growing problem around the world, but did you know that the diabetic foot ulcer treatment market alone is valued at over $3.15 billion?  Statistics like that mean the results of a report…

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62 Hospitals Sued for Fraudulent Patient EHRs and Falsified Claims

December 1, 2017

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

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

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

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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