Outsourcing RCM May Be More Trouble Than It’s Worth

Revenue cycle outsourcing may not be the financial answer hospitals are looking for, according to a recent analysis from the public accounting, consulting, and technology firm Crowe. The analysis of data from more than 1,000 hospitals across 45 states showed that hospitals outsourcing their entire revenue cycle reported higher claim denial rates and longer patient collection times…

Seasonal Changes to Hospital RCMs

Winter, spring, summer, and fall bring more than changes in weather, according to a recent analysis of over 1,000 hospitals. Seasonality also has a significant impact on hospital revenue cycle performance, with finance teams reporting fluctuations in net revenue and revenue cycle performance based on the time of year, consulting firm Crowe found. Using data from the…

7 Main Failures Leading to Payment and Resolution Delays

UTILIZATION This category accounts for 25% of all denied charges and includes the clinical areas of medical necessity, pre-authorization, DRG downgrades and experimental treatments. Insurance companies will often challenge whether a specific treatment was medically required, whether the level of care provided corresponded to the underlying morbidity, or whether the length of stay was justified.…

Importance of Chargemaster Upkeep

ENSURING HOSPITAL CHARGEMASTER MAINTENANCE Hospital chargemaster maintenance is the primary responsibility of the designated team or coordinator. Maintenance is a continuous process that ensures all services are accurately charged, the hospital is compliant with government regulations for pricing, and the organization receives accurate reimbursement. Hospital chargemaster maintenance can be especially challenging as public and private…

Hospital Chargemaster Explained

WHAT IS A HOSPITAL CHARGEMASTER? Hospitals, and to a lesser extent physician practices, use the chargemaster to create a summary of charges and services. Hospital leaders also use chargemaster data to track service volume, costs, and revenue. For each service, the chargemaster includes the following components: Item number that is assigned by the facility and unique…

Hospital Leadership Behind on Discussing Charge Capture

Over three-quarters (78 percent) of revenue cycle leaders at acute care organizations agreed charge capture is essential to an organization’s success, yet most leadership teams only discuss charge capture once a month or less. Those were the findings from a new survey conducted by Sage Growth Partners for analytics company Ingenious Med. Researchers surveyed 104 leaders in…