Revenue Cycle Management

Since 2005, Denver Health has saved more than $200 million as a result of using a lean management philosophy to fine-tune operations and clinical processes. That's especially important these days, as hospitals and health systems have assumed more financial risk in delivering care.

Hospitals' struggle for financial sustainability continues and may be getting worse, as CFOs say information technology investments draw more resources than expected and threaten to crowd out other priorities.

Hospitals and health systems want to mitigate their compliance spend as much as possible, as well as reduce the odds of facing large penalties for being out of compliance. The path to lowering the costs of compliance starts with putting appropriate policies and procedures in place -- and getting the right people at the table to make that happen.

The Centers for Medicare and Medicaid Services late last week released the 2015 Physician Fee Schedule final rule, and it brings a number of changes that doctors and practice managers need to understand about chronic care management, the Medicare conversion factor and other key reimbursement issues.

It's the rare hospital that has never experienced delays in receiving reimbursement as a result of clinical documentation coding snafus. But hospitals that don't make a serious stab at clinical documentation improvement (CDI) will be poised to take an even harder hit come October 2015, the start date for ICD-10 implementation.

The CY 2015 final rule for the home health prospective payment system updates Medicare payment rates to home health agencies, and implements the second year of the four-year phase in of the rebasing of the payment system.

While some health systems are reluctant to publish prices without reforms of insurance practices and proper context for patients, some are trying to embrace transparency as a new model. Washington State's Everett Clinic is one of those pioneers.

Following an "industrial model of care," New York's Westmed Medical Group analyzes data from more than 2,200 processes and procedures to drive accountability and results. This has led to 15-fold growth and $285 million in annual revenue.

Though over 30 states have passed or proposed legislation to increase healthcare price transparency, and released median prices for specific services, many supporters of price transparency have pushed for more detailed data.

Commercial insurers inaccurately process about 20 percent of claims filed by medical practices. It's an industry standard that has weathered the test of time -- though not in a good way.