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Revenue Cycle

Practical solutions for all aspects of healthcare revenue cycle management, including patient access, charging, coding, billing, revenue collection, and auditing. Tools, expert guidance, and education to ensure appropriate reimbursement and comply with Medicare regulations.

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  • Heard this week

    “Be aware of your surroundings, be aware of the mood, the level of burnout of the people with whom you work most closely. And when you see someone is in trouble, do something about it.”


    -Kevin Hopkins, MD, medical director at the Cleveland Clinic Strongsville Family Health and Ambulatory Surgery Center in Strongsville, Ohio, explains the importance of noticing the signs of burnout in fellow physicians.
     

  • New for RPA subscribers only: Orientation debrief: How can we reduce information overload for new trainees?

    Now that orientation is over, it is a good time to reflect on its effectiveness. I have been doing this job for 10 years, and although I love this time of year, it is very exhausting. I have done orientation in many programs and in many ways, and I always want to take time to reflect on how effective a particular orientation really is, regardless of how many years it has been done a certain way. Read more.

  • CMS continues shift to value over volume in 2016 IPPS final rule

    CMS finalized changes to multiple quality measures in the fiscal year 2016 IPPS final rule, released July 31.

  • CMS, ONC release EHR Incentive Programs and 2015 Edition Health IT Certification proposed rules

    The Centers for Medicare and Medicaid Services (CMS) and Office of the National Coordinator for Health Information Technology (ONC) released two proposed rules designed to improve care delivery and experience and enhance the sharing of electronic health information.

  • CMS finalizes two-midnight inpatient presumption as part of 2014 IPPS final rule

    CMS finalized a major change to its inpatient admission guidelines as part of the 2014 IPPS final rule, released August 1.

    As part of the rule, CMS finalized the two-midnight presumption for inpatient admissions. If a patient the physician expects a patient’s treatment, testing, or surgery to require an inpatient stay covering two midnights, and admits the patient based on that belief, CMS will presume that the stay is be medically necessary.

    CMS emphasized that the physician must formally order an inpatient admission, but added that the physician can consider the time the patient has already spent in the ED or observation when deciding whether to admit the patient.

    CMS made the change in part to reduce long outpatient or observation stays.

    CMS also finalized the timely filing requirement for Part A to Part B rebilling. In March, CMS released a ruling and a proposed rule allowing hospitals to rebill Part A inpatient services as Part B outpatient services if the inpatient stay was not medically necessary and the services would have been covered in the outpatient setting. The ruling, which went into effect in March, did not including a filing timeframe. Under the final rule, hospitals will have one year from the date of service to rebill claims.

    CMS finalized the criteria to rank hospitals with a high rate of hospital-acquired conditions (HAC). Hospitals in the lowest quartile for HACs will see a payment reduction of 1%.

    Look for more analysis of the rule from HCPro next week.

  • Two-Midnight Rule: Initial Reviews to Resume

    Having taken time out for retraining and internal audits, contractors may resume initial-phase reviews of Medicare reimbursement claims for short-stay inpatient hospital care, CMS says.

Quick Poll

What part of the ICD-10 transition has been most difficult for your facility?

  • 53%: Documentation lacking necessary detail
  • 19%: We haven't had any major issues
  • 17%: Decline in coder productivity
  • 4%: MACs denying claims due to LCD mistranslations
  • 3%: Software issues related to EHRs
  • 1%: MACs holding claims for manual review
  • « Back

Revenue Cycle Blogs

Healthcare revenue cycle managers will find the latest resource on RACs, coding and billing, chargemasters and observation status and more.
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Spotlight

  • Clinical Documentation Improvement Boot Camp Online

    Clinical Documentation Improvement Boot Camp Online

     

    The bestselling Clinical Documentation Improvement Boot Camp® is now available online! Can't take a week out of work to train? Now fit the online course into YOUR schedule!

    Using a combination of online lecture, interactive course work, exercises, and instructor conference calls, this intensive two-week course gives you the same content, tools and skills that our live Boot Camp provides for all medical and surgical specialties.

    CDI-specific education covering:

    • Medical record review and physician queries
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    • ICD-9-CM coding rules
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