Revenue Cycle Management
Most hospitals fall well short of their cost reduction targets, in part because the ability of chief financial officers to meaningfully impact how operational and clinical leaders approach the issue is limited.
New research suggests that socioeconomic factors can account for most of the geographical variation in Medicare spending. As a result, larger socio-demographic issues must be considered when assessing the quality of care offered by healthcare providers.
The Centers for Medicare & Medicaid Services has published a final rule updating the hospice wage index and payment rate for Fiscal Year 2015. It adopts a number of payment reforms addressing concerns about program integrity, beneficiary protection and quality.
A program that combines a mobile app, analytics and direct intervention is showing promise in reducing the costs associated with hospitals' most expensive patients -- the so-called "super-utilizers."
The value-based model of healthcare is gradually transitioning from the pilot phase to implementation, as health insurers and providers strive to offer better care while eliminating unnecessary costs. But for providers who have always been paid fee-for-service, it is a different way of thinking.
Predictive analytics uses a variety of statistical techniques that analyze current and historical facts in order to make predictions about the future. In the healthcare setting, such data analysis can be effective in addressing a variety of key issues, including preventable readmissions.
In its new rules, CMS places great emphasis on the physician's documentation regarding his or her expectation of a patient's need for hospital care and anticipated length of stay. Therefore, it is essential that all hospital physicians are educated about the heightened importance of documentation within the medical record.
Weill Cornell Physicians, Cornell University's physician group, has inked a new accountable care agreement with Aetna, intended to enhance care for approximately 9,000 of the insurer's commercial and Medicare members in New York.
According to the KISS principle, most systems work best if they're kept simple. Simplicity is the key goal in design, and unnecessary complexity should be avoided. Clinical documentation improvement and ICD-10 preparation are no exception.
Inpatient rehabilitation services are already a big target area for recovery audit contractors, and there will likely be more denials as audits ramp back up. Providers must remain consistent, proactive and vigilant to protect their revenue.