At the Margins

Our latest insight into health care margin improvement efforts

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by Sophia Duke-Mosier August 21, 2019

Struggles with patient collections and uncompensated care have increased, leaving hospitals scrambling for ways to collect on unpaid bills. But hospitals aren't the only ones scrambling—patients are continuously on the hook for more of their bills due to a shift from insurer to patient responsibility and rising out-of-pocket costs.

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Our take: This year's FY 2020 Inpatient Final Rule winners (and 2 other key insights)

Eric Fontana August 5, 2019

Late Friday, CMS continued the flurry of recent regulations by dropping the Inpatient Prospective Payment System Final Rule for Fiscal Year (FY) 2020. Unlike the headline-grabbing HOPPS proposal, this regulation was not expected to make major waves after a relatively tame inpatient proposal back in April. Nevertheless, our team will be scrubbing through the release over the next two weeks to examine the key provisions that will take effect on October 1, 2019.

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Make change a reality: How to gain stakeholder buy-in across the revenue cycle

by Robin Brand and Rachel Matthews July 31, 2019

Today's provider world moves at an impossibly rapid pace. Between mergers, EHR "go-lives," and staffing revamps, your revenue cycle has likely undergone significant change in the past year. In fact, research suggests that the average health care manager juggles five to 15 change initiatives at any one time.

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Medicare wants hospitals to disclose 'secret' prices, plus 2 other key takeaways from the 2020 HOPPS proposed rule

by Eric Fontana, Heather Bell, and Rachel Hollander July 30, 2019

Late yesterday, CMS released its proposed regulations for hospital outpatient departments (HOPDs) and ambulatory surgical centers (ASCs) in calendar year (CY) 2020.

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Does your pharmacy know the ins and outs of finance? How a specialist can cut billing errors.

by Robin Brand and Sophia Duke-Mosier July 17, 2019

What if an organization had a pharmacist dedicated to revenue integrity? The pseudonymed Beesly Health has just that—and it's helped the organization considerably reduce its billing errors.

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A new executive order could boost health care sharing ministry enrollment. Here's how to prepare.

by Robin Brand and Rachel Matthews July 10, 2019

The industry is buzzing over President Trump's recent executive order on improving price and quality transparency. However, while pundits devote their attention to the order's main component on price transparency, a smaller provision—with the potential to affect hospital collections—has flown under the radar.

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How Cedars-Sinai saved $76M with a simple audit strategy

by Robin Brand and Sophia Duke-Mosier July 3, 2019

Feeling attacked by audits?

Today's revenue cycle leaders often mention feeling attacked by the "regulatory tentacles," of government or non-audit requests at multiple entry points along the revenue cycle. The range of these audit types are seemingly endless, from RACs to MACs, LCDs, NCDs, QIOs, and audits from the Office of Inspector General--with revenue placed at risk from each one. Responding to, and mitigating, these audits can come at a high cost, requiring leaders to divert time and focus from other revenue cycle tasks to ensure compliance.

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The path to revenue cycle systemness starts with a vision. Here's how to build one.

by Anita Mago and Robin Brand June 24, 2019

While hospitals are starting to get a better handle on cost growth, margins still remain slim and much too close for comfort. In 2018, the median operating margin for nonprofit hospitals was just 1.7%. But minimizing cost is only one piece of the puzzle—skillful management of revenue cycle operations is just as critical. As we speak with our members across the country, we consistently get questions such as:

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