Preventing and Addressing the Many Dangers of Denials

February 17th, 2021 / Tyler Cowart / Posted in Revenue Cycle Management (RCM)

Hospitals and health systems have been managing shrinking profit margins for more than a decade. This past year, adding COVID-19 and the financial and operational impacts that come with it have made it more critical than ever for providers to focus on effective revenue cycle management. Yet, denials and denial write-offs continue to increase – …

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Don’t Let Underpayments Get You (or Your Revenue) Down

February 10th, 2021 / Tyler Cowart / Posted in Revenue Cycle Management (RCM)

Healthcare is well-known for the complexities and red tape associated with billing and insurance. On each the provider, payer and patient side, this is due to a wide range of complex, multifaceted factors, including complicated documentation and coding guidelines, billing problems and complex contract terms. There’s often a back-and-forth dance between all three parties to …

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The Risky Business of Risk Adjustment Coding and Auditing

January 29th, 2021 / Tyler Cowart / Posted in Payer Solutions

The world of risk adjustment is tricky – but critical to ensuring payers are fairly compensated for covering patients who are more likely to incur high healthcare costs. With risk adjustment, government programs such as Medicare and Medicaid will adjust the revenue provided to a health plan/payer based on the health of those covered.   …

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Top Strategies for Improving Your Medical Coding Audits

January 22nd, 2021 / Tyler Cowart / Posted in Health Information Management (HIM)

The one thing that never changes in healthcare is… change. In a world that’s constantly advancing, change is inevitable in the medical environment at every turn. Pandemics happen. Medical codes are added. Hospital policies change.  Industry payment models change.  Regulatory requirements change.  All of this comes at a great burden to health systems whose profit …

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In the Extended Wake of COVID-19, is Outsourcing Medical Coding the Answer?

January 18th, 2021 / Tyler Cowart / Posted in Extended Business Office Solutions (EBO)

COVID-19 has hit healthcare organizations extremely hard – from both a financial and operational perspective. Managing new safety protocols, staffing, caring for COVID-19 patients, managing surge capacity, and allaying patients’ concerns all while trying to preserve the volumes needed to maintain operational margins. In 2020, 29 more hospitals filed for bankruptcy, and many more are …

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The Single Overarching Strategy That Will Help Improve Your Revenue Cycle

December 17th, 2020 / Tyler Cowart / Posted in Revenue Cycle Management (RCM)

In the world of revenue cycle, there are dozens of sound strategies that can help busy hospitals and healthcare organizations drive greater efficiency – but at the end of the day, there’s only one method that truly works. Sounds easy, right?  Unfortunately, when you’re considering the complexities of the revenue cycle – nothing is as …

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Natural Language Processing in Risk Adjustment Coding – It’s Not Just for Over-Reads

December 10th, 2020 / Tyler Cowart / Posted in Healthcare Technology, Payer Solutions

Risk Adjustment programs are here to stay as we move into a value-based world. With reimbursement for health plans and providers tied to these programs, ensuring they are lean, efficient, and providing ROI is a top priority. With that said, Risk Adjustment coding is no easy process with all the unstructured content found in electronic …

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Payers Under Fire – Meeting FHIR Deadlines

November 18th, 2020 / Tyler Cowart / Posted in Payer Solutions

As if 2020 wasn’t overwhelming enough for payers who are battling a global pandemic while navigating all the many changes it brings to policies and reimbursement – there’s also a mad dash underway to meet the deadline for Fast Healthcare Interoperability Resources (FHIR) exchange format standards which go into effect on July 1, 2021. This …

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Is Technology the Remedy for HEDIS Headaches?

November 10th, 2020 / Tyler Cowart / Posted in Healthcare Technology, Payer Solutions

Payers and healthcare providers alike are in the constant pursuit of the triple aim in healthcare – including better quality, greater value, and improved patient satisfaction – as the shift to value-based care continues. For every health plan on the market, it’s critical to review and evaluate quality performance on a regular basis to ensure …

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The Six Most Important Changes Coming to Medicare Advantage Plans in 2021

October 28th, 2020 / Tyler Cowart / Posted in Payer Solutions

Enrollment in Medicare Advantage (MA) Plans continues to climb each year. In fact, Medicare Advantage enrollment has doubled over the last decade. As the program takes on its increasing share of Medicare beneficiaries, staying abreast of changes and developments to the program remains more important than ever. Next year’s changes to Medicare Advantage are both …

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