Roades: What I learned from my discussion with state governors


At the Margins

Our latest insight into health care margin improvement efforts

Bundled services: Transitioning from cost savings to market share gains

by Natalie McGarry February 25, 2015

In April 2013, Medicare launched the Bundled Payment for Care Improvement (BPCI) Initiative to offer providers four voluntary bundled payment options. Now, more than 6,000 organizations are participating in the program.

Many participants also recognize consumers’ and employers’ interest in purchasing comprehensive and affordable episodes of care. And where there's demand, there's growth opportunity; an increasing number of providers are experimenting with private sector bundled payments as a tactic to grow market share.

Commercial Bundled Payment Tracker

Even Medicare is recognizing the power of including commercial payers in bundled arrangements by integrating private payer partnerships into the launch of the new bundled payment initiative, the Oncology Care Model. To appeal to purchasers, providers must create a bundled payment product that meets the needs and preferences of the market. Here are five key considerations to take into account before jumping in to your own bundled payment program.

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Will the ICD-10 deadline hold? Signs point to yes.

Christopher Kerns February 13, 2015

Whenever I speak with a CFO these days, there is a question that invariably—and I mean literally, without exception—comes up: Will CMS's October deadline for the transition to ICD-10 hold, or will it yet again get kicked down the road? If the recent congressional hearings are any indication, the odds of the deadline holding have improved markedly.

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Mid cycle: A buzzword finance execs should pay attention to

Jenny Love February 11, 2015

With the rise of pay-for-performance and quality-based purchasing, the functions in the middle of the revenue cycle—documentation, coding, and case management, which we call "mid cycle"—have become inextricably connected to financial performance.

I sat down with James Green and Jason Jobes, two of our foremost revenue cycle experts, to learn what this connection means for financial performance, and why finance executives should sit up and take notice.

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Survey results: A picture of today's CDI programs

by Ellie Stoller February 4, 2015

While clinical documentation improvement (CDI) programs work toward the same goal, many differences between programs exist. Interested to see how your CDI program stacks up against the rest? Check out our latest research below.

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Take some of the risk out of risk-based payments

Morgan Haines January 30, 2015

As health care moves from volume- to value-based reimbursement, accurate coding practices have never been more critical. Now is the time to ensure that all appropriate codes are being included. Failing to paint a comprehensive picture of the health of overall patient population can have significant financial consequences.

Many organizations I’ve worked with rush to conduct a coding review. Unfortunately, a coding review alone isn’t enough. Instead, I’ve seen the best-of-the-best start much earlier in the process—with the physician.

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From collections to competition: How to motivate front office staff

Patrick Kelley January 29, 2015

More and more patients are signing up for high-deductible plans, so it’s imperative you have strong point-of-service collection practices to maximize revenue. In fact, the average community hospital in non-Medicaid expansion states sees an additional $500K in bad debt.

To keep up, hospitals and health systems across the country are beefing up their front office capabilities, often by adding new technologies. But even the best technology in the world won't be enough if your staff can't use it effectively or have informed financial conversations with patients.

As a first step, make sure your staff feel prepared to ask patients for money respectfully and effectively. Role playing and scripting will help. Second, it’s critical to get your staff excited about collections! Create a collection campaign that will inspire your staff and encourage them to set new goals.

Point-of-service collections start with you: 4 ways to get your staff on board

I’ve worked with organizations across the country, helping them set up record-breaking collection campaigns and staff incentive programs. Here are some best practices I’ve seen:

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Dual coding: What we learned from 8,000 claims

by Ellie Stoller January 26, 2015

We’ve seen how 5% revenue reduction risk under pay-for-performance has gotten the industry’s attention. Our own research has also shown that ICD-10 can affect 4.8% of reimbursement revenue—a risk that merits attention as well.

Due to the potential reimbursement impact, hospitals are beginning to dual code patient claims, allowing ICD-10 project leaders to compare DRG assignment of the same claim under ICD-9 and ICD-10 and prepare for the changes.

Barnes Health (pseudonym), a system in the Midwest, began dual coding a year and a half ago and shared its data with us.

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In case you missed it: RAC contracts get renewed—but with new limits

Christopher Kerns January 12, 2015

CMS has said it will revamp its Recovery Audit Contractors (RAC) program in order to increase transparency between the agency and providers and to enhance its oversight of the program.

CMS has renewed RAC contractors for CGI Federal, Connolly, HealthDataInsights, and Performant Recovery, allowing them to audit claims until Dec. 31, 2015. Those auditors will all be subject to the new rules, which limit the patient status claims review period to six months, as long as the provider submits its claim within three months of the service date.

Case study: Generating an annual RAC reserve estimate aids financial planning

The rule change limiting lookback periods is a big assist to providers wishing to re-bill certain denied Part A claims under Part B. Because CMS limits re-billing to one year from the date of service, those providers who submit claims in a timely manner (within three months), will have lookbacks limited to only six months from the date of service. Previously, many providers were often hamstrung in their re-billing efforts with longer lookback periods allowed.

But while the change is an important acknowledgement from CMS that the RAC program is in need of overhaul, it is also a reminder to the industry that the program has been incredibly successful in its goal to reduce overpayments/fraud and slow the growth rate of health care costs. It's also a reminder that the federal government remains committed to continuing these efforts for the long-term.

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