Nearterm Blog

doctor on laptop providing telemedicine services

The ongoing pandemic named Covid-19 has been a world-wide public health event like we’ve never seen. Millions have been affected and nearly three-quarters of a million deaths have occurred in just a few months due to the virus. In the U.S, outbreaks continue to flair as communities and healthcare leaders struggle to balance the need…

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denial management in healthcare

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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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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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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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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RCM Consultants

Hospitals have been and still are classified in various ways, depending on the purpose of the hospital classification and how it is to be used. Examples include ownership, bed capacity, service capacity, specialty, teaching, acute care, critical access, location, research and there are many others. A “new normal” classification methodology has emerged and it is…

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The above image is an actual hospital bill and accompanying explanation of charges used in 1951. Just think of the things that we didn’t have to manage back then. A short list might include coding, claim edits, massive denials, contract payment compliance, Medicare/Medicaid (both started in 1965), managed care contracts, HIPPA regulations, “patient-friendly” billing initiatives,…

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I don’t know about you but I am growing immune to the voluminous “LISTS” I see in social media about leadership and success. LinkedIn, social media forums such as Facebook, and blogs are recently inundated with posts about leaders, leadership and successful people. For example, just this year alone 167 Habits, 340 Behaviors, 62 Graphic…

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People are more careful about their work when they understand the importance of what they are doing and how it impacts the organization. Recent findings suggest that this is particularly true for millennials, but it certainly applies to the broader work force as well. Here is one way to help access associates better understand their…

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