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Demystifying the Revenue Cycle: Becker’s Healthcare Podcast

Beckers Podcast: Demystifying the Revenue Cycle Listen to this Becker’s Healthcare Podcast interview with our Chief Operating Officer, Brett Palmer, and Adrienne Moore, Vice President of Revenue Cycle at Banner Health, as they discuss how Banner Health is effectively tackling revenue cycle challenges. Watch More See All Webinars

HIM Director Reflects on EHR Conversion A Year After Go-Live

HIM Director Reflects on EHR Conversion A Year After Go-Live Interviewees: Shannon Maio (CSD) | Senior Director, Client Success Kris Knight | Vice President, Clinical Documentation Tammy Stratton | HIM Director EHRs are a valuable tool for healthcare organizations, but when considering adoption and achieving the desired benefits, the failure rate can…

Revolutionizing the Healthcare Revenue Cycle: The Crucial Role of Interoperability Standards and AI

Revolutionizing the Healthcare Revenue Cycle: The Crucial Role of Interoperability Standards and AI Laxmi Patel | Chief Strategy Officer In the ever-evolving landscape of healthcare, the integration of artificial intelligence (AI) has emerged as a transformative force, holding the promise of revolutionizing patient care, diagnosis, and treatment. Yet, to fully unlock the potential…

Globalization: The Power of Global Centers of Excellence in the Revenue Cycle

The Power of Global Centers of Excellence in the Revenue Cycle Laxmi Patel | Chief Strategy Officer Given the financial and staffing challenges healthcare is facing today, globalization is here, and it’s here to stay. Globalization has gotten a bad rap for many years, but when fully understood and employed in the right…

Your EHR is the Most Powerful Tool You Have: Steps to Getting the Most Out of your Epic Investment

Your EHR is the Most Powerful Tool You Have: Steps to Getting the Most Out of your Epic Investment Laxmi Patel | Chief Strategy Officer Epic has changed the face of healthcare; becoming the one source of truth and reporting for many organizations. It provides a wide range of comprehensive functionalities across patient experience,…

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Maximizing Revenue and Compliance: The Vital Role of Revenue Integrity in Healthcare Organizations

Maximizing Revenue and Compliance: The Vital Role of Revenue Integrity in Healthcare Organizations KYLE SHERSETH | VP, Revenue Cycle Solutions The word integrity is defined as the condition of being unimpaired, or sound in construction. When applying this definition to your revenue cycle operations, having revenue integrity means that your healthcare organization is…

Finding Balance in Patient-Centric RCM

Finding Balance in Patient-Centric RCM Laxmi Patel | Chief Strategy Officer A successful revenue cycle should not be seen as a series of numbers, financial statements, and outcomes. It must encompass the entire patient journey, which should continue to be the central focus and the heart of healthcare. Unfortunately, in pursuit of efficiency and…

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Balancing the Use of Automation Within the Healthcare Revenue Cycle

Balancing the Use of Automation Within the Healthcare Revenue Cycle John Hataway | Senior Director – Continuous Improvement & Automation Typically, hearing the terms “Automation or AI” elicits one of two responses– an immediate sense of apprehension and avoidance, or a complete overestimation about its capabilities, though in some cases those two responses go…

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Is Your Hospital Using Price Transparency Data to be Competitive? 2 Benchmarks to Put You in the Lead

Is Your Hospital Using Price Transparency Data to be Competitive? 2 Benchmarks to Put You in the Lead Savvy hospitals are taking advantage of legislation that requires hospitals (and soon payers) to provide price transparency data to the public by using it to create new revenue cycle benchmarks. They’re building a capability to analyze…

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Getting the Most from your EHR Investment

Getting the Most from your EHR Investment Thought Leadership Getting the Most from your EHR Investment An EHR is one of the biggest investments a provider will make, adding up to millions, or even billions, of dollars in software, time, and resources. On average, an EHR can take six months to a year to implement,…

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Revenue cycle optimization improves net revenue through sustainable improvements

Revenue cycle optimization improves net revenue through sustainable improvements. Case Study Revenue cycle optimization improves net revenue through sustainable improvements. Decreased revenue and increased denials were a problem for this west coast acute care provider with 350+ beds and $1.1B NPR. Contributing to the reduced cash flow were authorization backlogs, billing inconsistencies and inferior workflow…

Savista revitalizes client’s revenue cycle operations through an expert workforce

Savista revitalizes client’s revenue cycle operations through an expert workforce. Case Study Savista revitalizes client’s revenue cycle operations through an expert workforce. Staffing shortages, high turnover rates, insufficiently trained employees and soaring labor costs are plaguing healthcare providers. This combined with increased work volume and outdated workflows, make a business office prone to errors in…

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Optimization eliminates redundancy and improves performance

Optimization eliminates redundancy and improves performance. Case Study Optimization eliminates redundancy and improves performance. A high functioning patient accounting system (PAS) drives revenue by producing accurate bills that are paid promptly. It promotes accurate registrations, streamlines bill submission, upholds compliance mandates, and supports a provider’s financial stability. When your PAS capabilities are not maximized, too…

Aged AR accounts collected at a rate triple the industry average

Aged AR accounts collected at a rate triple the industry average. Case Study Aged AR accounts collected at a rate triple the industry average. This 3-hospital system with a $1B NPR had a combined hospital and physician accounts receivable inventory >365 days of 6,400 accounts valued at $2.7M. Considered uncollectible and poised for write-off, the…

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Small balance recovery partnership resolves 90% of inventory and significantly increases revenue

Small balance recovery partnership resolves 90% of inventory and significantlyincreases revenue. Case Study Small balance recovery partnership resolves 90% of inventory and significantly increases revenue. A 5,500-bed, multi-state system with $6.7B NPR experienced growing AR days and frustrated staff due to high account volume that restricted their ability to analyze payer issues, reimbursement delays and…

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AR outsourcing partnership revitalizes revenue cycle operations and increases cash

AR outsourcing partnership revitalizes revenue cycle operations and increases cash. Case Study AR outsourcing partnership revitalizes revenue cycle operations and increases cash. This client with 215 beds and $277M NPR was a long-term partner that needed to revitalize operations and increase cash. Job loss due to the pandemic left their region with above average unemployment…

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Nationally recognized academic medical center sees 35% improvement in denial write-offs with outsourcing.

Nationally recognized academic medical center sees 35% improvement in denial write-offs with outsourcing. Case Study Nationally recognized academic medical center sees 35% improvement in denial write-offs with outsourcing. A physicians’ group for an 885-bed, $2.5B NPR academic medical center experienced a growing patient liability population resulting in a rise in uncompensated care, denial write-offs and…

Academic health system exceeds cash goal with streamlined revenue cycle

Academic health system exceeds cash goal with streamlined revenue cycle. Case Study Academic health system exceeds cash goal with streamlined revenue cycle. An academic health system with 2,700+ beds and $5.15B NPR experienced decreasing profit margin and cash flow from declining patient revenue, putting their financial health at risk. Bottom-line impact from a system conversion,…

Client clears backlog of abstraction and follow-up cases with Cancer Registry partnership

Client clears backlog of abstraction and follow-upcases with Cancer Registry partnership. Case Study Client clears backlog of abstraction and follow-up cases with Cancer Registry partnership. This academic health system with >1,000 beds and $2.9B NPR had a 12-month abstraction backlog and could not retain the resources needed to maintain timely completion. Confronted with a Commission…

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Holistic CDM management protects revenue and compliance

Holistic CDM management protects revenue and compliance. Case Study Holistic CDM management protects revenue and compliance. A 25-bed, $32M NPR western critical access hospital lacked the resources, and expertise to perform routine CDM maintenance, evaluate market prices, and transition to a new PAS, leaving a critical gap in the organization’s revenue integrity program. Download the…

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CDM standardization provides defensible charge practices and revenue neutrality during a multi-facility system conversion

CDM standardization provides defensible charge practices and revenue neutrality during a multi-facility system conversion. Case Study CDM standardization provides defensible charge practices and revenue neutrality during a multi-facility system conversion. IDN client with $15B+ NPR needed to transition 88 facilities with disparate chargemasters to Epic, a radically different structure, over a three-year time frame. Download…

“Auditing the auditor” uncovers a need for revenue cycle education and process improvement

“Auditing the auditor” uncovers a need for coding education and process improvement. Case Study “Auditing the auditor” uncovers a need for revenue cycle education and process improvement. A Midwest IDN client with 1,200 beds and $1.8B NPR was experiencing decreased coding accuracy and productivity, negatively impacting financial performance. Reliance on internal QA processes and a…

Partner leverages coding partnership expertise to mitigate compliance risk

Partner leverages coding partnership expertise to mitigate compliance risk. Case Study Partner leverages medical coding partnership expertise to mitigate compliance risk. A routine third-party audit reported high ER Evaluation & Management (E/M) error rates for an acute care hospital with 182 beds and $313M NPR. Incorrect reporting of these errors would skew current revenue and…

Client reduces AR days by 36% in 120 days

Client reduces AR days by 36% in 120 days. Case Study Client reduces AR days by 36% in 120 days. This 47-bed acute care hospital battled delayed reimbursement and missed revenue due to coding accuracy and productivity. They saw an increase of coding-related denials and lower-than-anticipated reimbursement levels. Coders had limited access to training resources…

Acute care facility leverages expert resources to successfully appeal clinical denials

Acute care facility leverages expert resources to successfully appeal clinical denials. Case Study Acute care facility leverages expert resources to successfully appeal clinical denials. A 200-bed, $509M NPR client lacked resources able to review and resolve their large volume of denials, nor did they possess the skill set to determine plausibility of certain clinical appeals.…

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Safety net system transforms denial backlog into $20M+ gain

Safety net system transforms denial backlog into $20M+ gain. Case Study Safety net system transforms denial backlog into $20M+ gain. This 800-bed, $532M NPR safety net system struggled with retaining the resources needed to address an immense denial backlog and lacked visibility into their root causes. This threatened cash collections and financial viability of the…

High-touch provider for complex populations reduces ineligible Medicaid dollars by 97%

High-touch provider for complex populations reduces ineligible Medicaid dollars by 97%. Case Study High-touch provider for complex populations reduces ineligible Medicaid dollars by 97%. BrightSpring, a complex care provider who assists clients residing in intermediate care facilities and/or receiving home-based services, saw a climbing number of ineligible Medicaid clients. This forced the client to write…

Non-profit system uses Epic optimization to improve enrollment process for patient eligibility

Non-profit system uses Epic optimization to improve enrollment process for patient eligibility. Case Study Non-profit system uses Epic optimization to improve enrollment process for patient eligibility. Jefferson Health, 607-bed, three hospital system experienced patient interview delays, slowed account conversion and increased risk of error when attempting to secure coverage for under and uninsured patients. Eligibility…

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Medicaid eligibility conversion and collections improved by optimizing enrollment processes

Medicaid eligibility conversion and collections improved by optimizing enrollment processes. Case Study Medicaid eligibility conversion and collections improved by optimizing enrollment processes. For this academic health system of 1,104 beds and $1.8B NPR, Medicaid eligibility processes were highly manual and workflow had not been assessed since their Epic transition. This resulted in fewer conversions, less…

Outsourcing partnership transforms HIM-related KPIs and reduces DNFC by 83%

Outsourcing partnership transforms HIM-relatedKPIs and reduces DNFC by 83%. Case Study Outsourcing partnership transforms HIM-related KPIs and reduces DNFC by 83%. What problems can revenue cycle management outsourcing solve? This 478-bed health system struggled with essential HIM performance metrics. The department had a sustained record completion backlog, ongoing troubles with coding quality and production, as…

Client transforms HIM KPIs and DNFC by 66% and continues to sustain improvements

Client transforms HIM KPIs and DNFC by 66% and continues to sustain improvements. Case Study Client transforms HIM KPIs and DNFC by 66% and continues to sustain improvements. This 25-bed critical access hospital with $130M NPR was not meeting their financial KPIs following an EMR implementation. They battled with inaccurate record filing, a backlog of…

Patient and physician satisfaction improved with patient access transformation

Patient and physician satisfaction improved with patient access transformation. Case Study Patient and physician satisfaction improved with patient access transformation. Inconsistent and ineffective patient access processes affected revenue and timely service delivery for this acute care facility with 407 beds and $273M NPR. Incomplete registrations, lack of coverage verification, authorization and financial clearance prior to…

Healthcare system collects $21.3M in underpayments with payment variance partnership

Healthcare system collects $21.3M in underpayments with payment variance partnership. Case Study Healthcare system collects $21.3M in underpayments with payment variance partnership. A healthcare system sought to maximize yield from insurance payers to maintain financial health. Increasingly complex managed care contracts, downgraded DRGs and billing and payer discrepancies resulted in lower-than-expected reimbursement. Download the Case…

Client increases cash collections during height of the pandemic with strategic AR support

Client increases cash collections during height of the pandemic with strategic AR support. Case Study Client increases cash collections during height of the pandemic with strategic AR support. An acute, safety net system of 323 beds and $532M NPR was experiencing a revenue decline and a growing volume of at-risk patients. The pandemic had eroded…

Provider eliminates cost, drives revenue, and optimizes Epic technology through data analytics

Provider eliminates cost, drives revenue, and optimizes Epic technology through data analytics. Case Study Provider eliminates cost, drives revenue, and optimizes Epic technology through data analytics. An academic medical center of 330 beds and $700M+ NPR experienced growing self-pay inventory, increased days to pay, and decreased payment volume and amount despite census stability. They sought…

Client collects an additional $5M while increasing patient satisfaction

Client collects an additional $5M while increasing patient satisfaction. Case Study Client collects an additional $5M while increasing patient satisfaction. This client of 402 beds and $647M NPR needed to improve balanceafter insurance, self-pay collections. The patient experience and self-paycollection rate was faulting partially due to confusing statements and thepatient payment system. Download the Case…

Back-end integration creates streamlined, best practice recovery processes

Back-end integration creates streamlined,best practice recovery processes. Case Study Back-end integration creates streamlined, best practice recovery processes. Poor patient communication and inconsistent statement delivery at this 571-bed system led to declining revenue, poor patient satisfaction anddemoralized customer service staff. They needed healthcare revenue cycle expertise to oversee the entire patient responsibility inventory, improve performance visibility…

Patient access crisis drives innovation

Patient access crisis drives innovation. Case Study Patient access crisis drives innovation. Covid-19 incited a meteoric rise in emergency room visits. This surge in patients necessitated additional staff, increased registration efforts, and expanded follow-up services at the same time the pandemic created staff shortages and state mandated restrictions in onsite patient interactions. Fueling the obstacles,…

CDM compliance and strategic pricing supports revenue goals

CDM compliance and strategic pricing supports revenue goals. Case Study CDM compliance and strategic pricing supports revenue goals. Savista set out to reallocate $85M while ensuring defensibility of charges, maintaining gross revenue neutrality and optimizing net revenue. CDMadjustments needed to comply with industry standards and federal regulations and drive strategic benchmarking. Our revenue cycle management…

Webinars/Videos

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Demystifying the Revenue Cycle: Becker’s Healthcare Podcast

The CDM – Leverage its Power to Drive Revenue and Compliance

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Value of Patient Balance Management Program

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Maximizing Eligibility and Enrollment Through Virtual Technology

Becker’s Healthcare Webinar: The Link Between QA, Education, Impact & Value

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Every code tells a story: How to bolster clinical documentation accuracy and success

Articles

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Demystifying the Revenue Cycle: Becker’s Healthcare Podcast

HIM Director Reflects on EHR Conversion A Year After Go-Live

Revolutionizing the Healthcare Revenue Cycle: The Crucial Role of Interoperability Standards and AI

Globalization: The Power of Global Centers of Excellence in the Revenue Cycle

Your EHR is the Most Powerful Tool You Have: Steps to Getting the Most Out of your Epic Investment

Maximizing Revenue and Compliance: The Vital Role of Revenue Integrity in Healthcare Organizations

Finding Balance in Patient-Centric RCM

Balancing the Use of Automation Within the Healthcare Revenue Cycle

Is Your Hospital Using Price Transparency Data to be Competitive? 2 Benchmarks to Put You in the Lead

Getting the Most from your EHR Investment

Make the Most of Price Transparency Data: Charge and Reimbursement Benchmarking

Make the Most of Price Transparency Data:Charge and Reimbursement Benchmarking Thought Leadership Make the Most of Price Transparency Data: Charge and Reimbursement Benchmarking With the introduction of Hospital and Health Plan Price Transparency regulations and increasing prevalence of high deductible health plans, hospital chargemasters have become price comparison tools for creating revenue cycle benchmarks. In…

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Steps to Improve Patient Satisfaction and Increase Revenue

Steps to Improve Patient Satisfaction and Increase Revenue Thought Leadership Steps to Improve Patient Satisfaction and Increase Revenue The enormous influx of eligible Medicaid and community benefit participants poses both an opportunity and challenge for healthcare providers. The shortage of trained staff and the changing healthcare landscape demands that providers think “outside the box” to…

Want to Shore Up a Sagging Bottom Line? Start With Your Chargemaster

Want to Shore Up a Sagging Bottom-Line? Start With Your Chargemaster Up to 1% of net patient revenue is lost due to deficient charge capture processes. According to the Healthcare Financial Management Association (HFMA) April 29, 2022, the charge description master, or CDM, is a major source of revenue leakage for healthcare providers. Understanding the…

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CDM Conversion Strategy: Savvy Steps For PAS Success

CDM Conversion Strategy: Savvy Steps For PAS Success Healthcare providers can relate to the huge investment of a new patient accounting system, or PAS. The time, money and resources required plus the expected dip in financial performance during transition – it’s a lot. Which makes managing the dip and reducing recovery time after go live…

The CDM – Leverage its Power to Drive Revenue and Compliance

The CDM – Leverage its Power to Drive Revenue and Compliance For too long, the Charge Description Master has taken a back seat to Patient Access, HIM and A/R when it comes to driving net revenue and ensuring compliance. Plus, recent price transparency regulations have prompted providers to share information that they’re making public is…

Value of Patient Balance Management Program

Value of Patient Balance Management Program What is the value of a patient balance management program? Patient financial liabilities are skyrocketing and insured bad debt is growing beyond uninsured bad debt. Providers need robust Patient Access services and technology with a patient-centric approach that helps patients understand complex information about their care and how they…

Public Health Emergency (PHE) Renewed. Medicaid Extended Again.

Public Health Emergency (PHE) Renewed. Medicaid Extended Again. April 13, 2022 Recently Reuters reported that the COVID-19 PHE (Public Health Emergency) end date has been pushed back after a renewal. The extension allows “millions of Americans to keep getting free tests, vaccines and treatments for at least three more months,” according to the news…

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The Benefits to Outsourcing and Globalization of Healthcare

The Benefits to Outsourcing and Globalization of Healthcare Listen to this Becker’s Healthcare Podcast interview with our Chief Strategy Officer, Laxmi Patel to learn more about revenue cycle outsourcing. How can RCM outsourcing help your healthcare organization? Watch More See All Webinars

Strategic Partnerships and Outsourcing to Confront Labor Shortages

Strategic Partnerships and Outsourcing to Confront Labor Shortages Strategic Partnerships and Outsourcing to Confront Labor Shortages As the onslaught of COVID-19 persists into a yet another calendar year, the healthcare sector remains entrenched in economic pressure. The Great Resignation of 2021 saw record numbers of people quitting their jobs amid the pandemic, with…

Ensure Sustained Financial Growth with Effective Outsourcing

Strategic partnerships: Key areas of focus for revenue cycle leaders in 2022

Top 3 Biggest Revenue Cycle Challenges for Healthcare Organizations

Top 3 Biggest Revenue Cycle Challenges for Healthcare Organizations The healthcare management space remains fluid and dynamic as new industry trends continue to surface in the wake of the global pandemic. It’s no surprise that demand for healthcare revenue cycle management expertise is potent as ever, given the tremendous financial pressures at play for…

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Leveraging Outsourcing to Optimize Financial and Operational Outcomes

Leveraging Outsourcing to Optimize Financial and Operational Outcomes Revenue cycle outsourcing continues to gain widespread traction throughout the healthcare industry. Contracting certain business functions to external partners has become a boon for healthcare organizations looking to cut costs, increase efficiency, and keep up with the changeable commercial landscape. The ongoing impacts of the pandemic…

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Social determinants of health and value-based reimbursement

Social determinants of health and value-based reimbursement Two of the biggest trends in modern health policy are shaping the evolution of today’s Medicaid programs. For starters, the shift towards value-based payment (VBP) is helping providers address health-related factors beyond a patient’s immediate need for care. Along with an increasing emphasis on social determinants of health, this shift is…

Minimizing Financial Risk in a Consumer-Driven Environment

Minimizing Financial Risk in a Consumer-Driven Environment When examining today’s consumer-driven approach to healthcare, there are multiple factors to consider in order to minimize financial risk and ensure appropriate reimbursement. Understanding your patients is the first step. Patients have gained increased control in the business of healthcare over the years, especially given the expansion of virtualization…

Ensuring Sustainable Revenue Cycle Health At Skilled Nursing Facilities

Ensuring Sustainable Revenue Cycle Health At Skilled Nursing Facilities With a focus on cutting costs, today’s payers are looking closely at site of care when it comes to treatment options. Hospitals are among the most expensive sites of care, prompting a general shift towards skilled nursing facilities (SNF) as an alternative. According to Becker’s Hospital Review,…

Are Medicaid eligibility requirements negatively impacting your bottom line?

Are Medicaid eligibility requirements negatively impacting your bottom line? With limited income and resources, a significant portion of today’s population depends on Medicaid for assistance with mounting healthcare costs. At the same time, Medicaid’s complexity leaves many qualified patients confused as to how to achieve and maintain coverage. For starters, Medicaid eligibility requirements…

Maximizing Eligibility and Enrollment Through Virtual Technology

Maximizing Eligibility and Enrollment Through Virtual Technology Are you ready to improve patient engagement? Watch this Modern Healthcare webinar replay featuring Savista revenue cycle management experts and see how your healthcare organization can enhance healthcare Eligibility and Enrollment today. During this virtual webinar, Laxmi Patel and Aimee Newson discuss how, given current and future…

Drive Revenue with a Patient-First Approach

Drive Revenue with a Patient-First Approach Savvy hospitals and health systems are trending towards the tenets of consumerism as they look to cultivate a more patient-centric approach. In the interest of the patient, healthcare organizations are steadily adopting more “retail-like” behaviors, including 24-hour scheduling and other services that operate around the clock using revenue cycle…

Opportunities for Virtualization in the Healthcare Revenue Cycle

Opportunities for Virtualization in the Healthcare Revenue Cycle Due to the persistence of COVID-19, today’s healthcare environment relies heavily on telehealth as a viable – and often preferred – option for routine patient care. It’s no secret that the onslaught of the pandemic prompted providers nationwide to transition from in-person healthcare services to telephone and…

FAQs

Have Questions about the revenue cycle? We've got answers. Here are some answers to questions we frequently hear about revenue cycle best practices.

What can healthcare facilities do to cut costs?

Healthcare facilities can cut costs by assessing their revenue cycle for opportunities to optimize processes and workforce. Ensure your technology is optimized and used to the fullest of its capabilities. Improve supply chain, streamline management structures and improve patient throughput.

What are the stages of the revenue cycle?

Which stage of the revenue cycle is most important?

Each stage of the revenue cycle is important and necessary but there are imperative tasks for timely, optimal reimbursement.

Pre-registration: accurate patient information should be collected, and all prior authorization determinations made. Patient financially cleared for point of service.
Point of service: collect patient portions for service including copay or self-pay balances
Claim submission: appropriate codes supplied on patient claim along with all necessary documentation to support
Claim follow up: any factor could cause the payer to deny the claim. Follow up is important to determine correction or appeal.
Patient liability collections: providing accurate statements and follow up for collection of payment balances. If it turns to bad debt (generally over 120 days), it is imperative to follow state guidelines and regulations for compliant collections.

What are revenue cycle best practices?

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