Nearterm Blog

physician revenue cycle metrics

Top Revenue Cycle Key Performance Indicators

Healthcare organizations must manage their revenue cycle with an approach that balances patient care and quality. Due to increasing medical and drug costs paired with higher insurance premiums and deductibles, efficient revenue cycle management (RCM) is more important than ever. There are many indicators one could use to gauge the effectiveness of various elements of…

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what is a healthcare clearinghouse?

What is a Healthcare Clearinghouse & Why Use One?

Modern medicine in the United States includes a complex relationship between healthcare providers and insurance payers. Technology plays a critical role in electronic data interchange (EDI) between payers and providers, but the wide variety of software systems used can make seamless connection difficult. The Health Insurance Portability and Accounting Act (HIPAA) addresses the importance of…

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current healthcare management issues

Current Issues in Healthcare Administration and Management

There are many healthcare management challenges in the U.S. today. Some of these problems have evolved slowly overtime as a result of growing, complex, and diverse healthcare offerings. Rising costs in almost every area have been impacting hospitals and other healthcare providers as well as patient willingness to seek care. Regulatory changes have also introduced…

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SILENT IMPRESSIONS

Every encounter we have with another person or a business results in an impression. An encounter may be conversation, email, voicemail, text, social media, appearance, hygiene and others. Some of the impressions we form based on these encounters are stronger than others and because people are all different, reactions vary. Some impressions are indelible and…

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denial management in healthcare

Improving Denial Management in Healthcare & Medical Billing

When insurers deny medical claims, it takes a bite out of your revenue every year. Nationwide, this annual loss amounts to $262 billion, according to Modern Healthcare. As a matter of fact, insurers deny an average of 9 percent of claims overall, which means that your staff is engaged in a continual process of managing and appealing…

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Revenue Integrity & Capture – Who’s Herding the Cats?

Cross functional processes can be difficult to manage in hospitals. One reason pertinent to Revenue Integrity is that typically, the organization structure is a series of vertical disciplines with differently defined focus (HIM, PFS, PATIENT ACCESS, ANCILLARY DEPARTMENTS, MD’s, et.al.). This structure can be and is very effective in many hospitals. However, revenue integrity management…

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Revenue Cycle Processing Backlogs Are Not “NORMAL”. It’s time to raise the bar – eliminate BACKLOG TOLERANCE!

I talk every week with Revenue Cycle Leaders from all types of hospitals around the country. When I ask how things are going, there are many common responses that reflect current concerns and challenges they are facing. These include conversion issues, staffing constraints, volume fluctuation, talent acquisition/retention, cooperation among stakeholders, change in payor practices and…

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rcm solutions

Hospitals Staffing Levels Improve With RCM Solutions

There’s no doubt that healthcare workers are the backbone of the health service, so it makes sense for a healthcare provider to manage their staffing levels in a strategic manner. Healthcare revenue cycle management consulting services (RCM) help hospitals to meet staffing needs while saving money. This cost-effective approach is gaining momentum as healthcare providers strive…

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Should Hospitals Leverage Outsourced Coding or Keep It Internal?

Hospitals have adapted many different coding models. Most are designed around contributing factors that differ from one facility to the next. However, there are three models that arguably prevail. The following is a summary of each; MODEL I-INTERNAL All coding functions are managed and performed by internal staff/employees. The function is generally housed at the…

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