For many years, healthcare organizations operated exclusively under fee-for-service reimbursement models. The more services provided, the more healthcare providers were paid. But the model was allowing costs to spiral out of control and quality to suffer. Value-based healthcare is now poised to address this cost/quality challenge by reimbursing provider organizations based on the quality of […]
The healthcare landscape becomes more complex by the day. Value-based care. Regulatory requirements. Systems integration. Resource constraints. Payer payment tactics. All of these items, in addition to maintaining efficient daily operations, create challenges for the revenue cycle. Clinical and financial resources, processes, and technology have typically been siloed, but in today’s environment, it is critical […]
Now more than ever, the management of complex denials is paramount for organizations due to changes in payment methodologies, payer requirements, and patient consumerism. Navigating denials requires revenue cycle leaders to perform a “balancing act” that addresses both the management of complex, current denials, and prevention of reoccurring, systemic denials in the future. Health information management (HIM) […]
There was a time, not so long ago, that when a physician assigned a diagnosis to a patient, no one questioned the validity of their medical knowledge. As a matter of fact, I imagine such an inquiry would have been laughable. But, the evolution of electronic medical records, documentation requirements and the need to appease […]
A solid foundation is important to any structure. Likewise, solid documentation serves as the clinical foundation for healthcare organizations. In a previous blog post, we discussed the importance of the True Clinical Picture and the instrumental role health information management (HIM) professionals play in data governance. In this post, we’ll focus on documentation and why comprehensive, […]
To say that health information management (HIM) has changed is an understatement. From a paper-based system of recording medical encounters to today’s industry that has been transformed through the widespread use of technology, analytics, and artificial intelligence, the role of an HIM professional continues to evolve. And at the core of HIM is the data […]
Over the past few years, CMS has made known their intent to perform a comprehensive CC/MCC analysis to assess the appropriateness of each diagnosis codes ‘CC severity’. CC severity is the term used to describe a codes role as a DRG influencer in the inpatient prospective payment system. We know these roles to be MCCs […]
Denials are exciting! They come to challenge us, to make us think, help us to grow, and in the end, perhaps even prevent them from reoccurring. Your burning questions are why and how? Denials are opportunities, in fact, denials are great opportunities for growth and organizational success. But you’re probably thinking that denials are also […]
