Why the Government is Outsourcing (and You Should, Too)

Posted in Accounts Receivable (A/R), Health Information Management (HIM), Revenue Cycle Management (RCM)

The data is clear – policymakers are making every effort to reduce healthcare costs, particularly as states struggle with significant budget deficits across the country. To do this, many state governments have elected to outsource the management of Medicaid and Medicare programs to managed care companies. According to Modern Healthcare, 34% of Medicare beneficiaries are now enrolled in a Medicare Advantage plan, which is administered by a private payer. Similarly, 77% of Medicaid beneficiaries are enrolled in some form of managed care plan.

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Is It Time for a Billing Operations Check-Up? How to Assess the Health of Your Revenue Cycle

Posted in Accounts Receivable (A/R), Offshore Medical Billing, Outsourced Medical Billing, RCM Solutions

Balancing the competitive landscape that comes with physician practice consolidation combined with population health and the shift to value-based care is a lot to consider for busy hospital physician practices. Add in the constant changes in regulatory guidelines, enhancing the patient experience and most importantly – a continued focus on quality and safety and most hospital administrators have little resources left to focus on improving the revenue cycle.

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Best Practices for Identifying Patients Who Have the Propensity to Pay Before and During POS

Posted in Accounts Receivable (A/R), Medical Billing BPO, Offshore Medical Billing, Self-Pay Collections

With cash flows declining, margins shrinking, and bad debt on the rise, it’s more important than ever for healthcare providers to maintain a steady stream of income. If your organization has not implemented an end-to-end, comprehensive best practices revenue cycle management (RCM) solution, it is time to do it! You don’t have to add staff; just call …

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Sobering Statistics about Growing Patient Self-Pay Amounts

Posted in Accounts Receivable (A/R), Best Practices, Business Process Outsourcing (BPO), Knowledge Process Outsourcing (KPO), Offshore Medical Billing, Self-Pay Collections

With the growing number of high deductible insurance plans and the Affordable Care Act (ACA), patients are now responsible for up to 35 percent of their healthcare delivery costs. Here are some staggering facts from MGMA and McKinsey & Company: – Patient A/R growing to $660 billion in 2015 – $65 billion in bad debt …

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Patient Choice Is Driving Growth in Urgent Care Centers and Free Standing Emergency Departments

Posted in Accounts Receivable (A/R), Business Process Outsourcing (BPO), Knowledge Process Outsourcing (KPO), Offshore Medical Billing, Self-Pay Collections

The amounts for insurance deductibles continue to grow each year and there is no end in sight to these increases. With more and more patients opting for high deductible, low premium commercial health insurance policies, and the growing usage from the Affordable Care Act (ACA), providers must seek ways to collect these large deductible amounts …

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With the Start of ICD-10, It’s Now About Reducing the Denial Rate

Posted in Accounts Receivable (A/R), Best Practices, ICD-10, Insurance Billing Solutions

The world did not come to an end on October 1, 2015. With the start of ICD-10, healthcare professionals anticipated an overall reduction in productivity of their billing staff. In a pre-October 1 survey, 94% of respondents indicated that they expected increased denials, but only 30% had done any work toward solving the problem. If …

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Compliance with Credit Balance Resolution Rules Does Not Have to Be Difficult

Posted in Accounts Receivable (A/R), Credit Balance Resolution, Revenue Cycle Management (RCM)

Credit balances are unavoidable and time-consuming. However, by law, they must be resolved. This activity does not have to be difficult even for already over-worked billing staffs. Professional outsourcing services are available to help with this growing challenge. These services can be customized to fit into your specific workflow and increase your staff’s productivity, allowing …

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Six Benefits and Results of Having a Good Credit Balance Resolution Program

Posted in Accounts Receivable (A/R), Credit Balance Resolution, Revenue Cycle Management (RCM)

In today’s healthcare environment, credit balances are commonplace. The healthcare industry has a high incidence of credit balances due to multiple parties paying claims. The way that various information technology (IT) systems operate also creates credit balances. Each provider must determine its credit balance strategy — implement an internal program, which usually requires adding staff; …

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10 Best Practices for Credit Balance Resolution

Posted in Accounts Receivable (A/R), Credit Balance Resolution, Revenue Cycle Management (RCM)

Credit balances are simply a part of everyday life in the delivery of healthcare services. Unresolved credit balance accounts can distort the profitability of a healthcare facility and foster financial risks. Researching and correcting posting errors, duplicate payments, overpayments, and misapplied credits are not only time consuming, but also expensive. However, failure to address these …

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ERAs Are a Win-Win over Paper EOBs

Posted in Accounts Receivable (A/R), Electronic Remittance Advices (ERAs), Explanations Of Benefits (EOBs), Insurance Billing Solutions, Revenue Cycle Management (RCM)

The introduction several years ago of the ERA (Electronic Remittance Advice) created a quantum leap in the healthcare billing arena by providing an improvement to the traditional, paper-based EOBs. Astonishingly, many providers have not taken advantage of this revolutionary change. It has been estimated that even today only 46 percent of the claims are processed …

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