American health systems, hospitals and post-acute care providers are required to comply with hundreds of regulatory requirements. Facilitating this compliance comes with a high cost. According to the American Hospital Association, the average-sized community hospital spends nearly $7.6 million annually on administrative activities to support regulatory compliance. With the impending end of the COVID-19 public health emergency set to shake up healthcare regulations, ongoing healthcare labor
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American Hospital Association
Why It’s Time for Intelligent Prior Authorization
The Centers for Medicare & Medicaid Services (CMS) recently proposed a new rule to advance interoperability and improve the prior authorization (PA) process for Medicare and Medicaid patients. Specifically, the rule stipulates that health plans adopt electronic prior authorization processes, adhere to shorter turnaround times, clearly communicate denial reasons, publish key metrics annually, and implement the Fast Healthcare Interoperability Resources (FHIR) Application Programming Interface
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Digital Fax Solutions Alleviate Administrative Burden and Reduce Costs
At the LeadingAge Illinois 2022 Annual Meeting, Elizabeth McLaren, VP of Reimbursement and Community-Based Services, along with Steven Wermuth, MPA at Strategic Health Care, presented their analysis on the top billing mistakes. What did they find? Within long-term care providers, 8-10% of Medicare Advantage claims were denied. Shockingly, the 10% denial rate impacted revenue by $200 million! They also found that 80% of denied claims are due to missing or incorrect information used during intake
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A Hybrid, Technology-Driven Approach to Overcome Coding and RCM Staff Shortages
Exacerbated by pandemic-induced burnout, resignations, and even terminations1, chronic coding and revenue cycle management (RCM) staffing shortages have healthcare organizations struggling to find ways to keep revenue flowing despite a lack of qualified professionals to handle critical processes. It is a situation that has been brewing for years, as too few qualified professionals are entering professions that are expanding more rapidly than ever before. According to the American Hospital
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Breaking Down the Implications of New No Surprises Act Regulations
The importance of the No Surprises Act (NSA) cannot be overstated, as surprise medical bills have long been burdensome for patients in the U.S. healthcare system. In fact, more than half of all U.S. consumers have received an unexpectedly large medical bills. The purpose of the No Surprises Act is to prevent surprise out-of-network bills, often for emergency services. For example, if your appendix bursts while at work, you would be rushed to the nearest hospital for an emergency
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Is It Finally Time for Hospital-at-Home or is Time Up?
All the signs point to a bright and expansive future for hospital-at-home programs, which have been growing steadily since the Centers for Medicare and Medicaid (CMS) created the Acute Hospital at Home waiver program in November 2020. As of March, nearly 100 health systems and more than 200 hospitals in 34 states had been approved for the program. Meanwhile, Forrester predicts the number of hospitals delivering acute care at home will triple in 2022. The reasons why are compelling: a study
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Innovative, Non-Invasive Technologies Advanced Earlier Detection & Monitoring of Liver Disease
Leveraging technological advances to facilitate new ways of engaging patients and integrating non-invasive technology into a liver disease program not only serves to improve individual outcomes and reduce costs but also strengthens the financial performance of health systems and provider organizations that include this approach to testing. At a time when America’s hospitals and physician groups face lost revenues due to the COVID-19 pandemic, there is a pressing need for reducing costs while
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Your Room is Ready: How to Recapture Health System Revenue by Solving “The Motel Problem”
Healthcare leaders attempting to regain some of the revenue lost during the COVID-19 shutdowns now face a formidable challenge. The American Hospital Association estimates that U.S. hospitals and health systems lost $202.6 billion in just the four months from March 1 through June 30—roughly $50.7 billion per month. Many variables feed into the overall financial impact for individual healthcare organizations, of course—including geographic location, local ordinances, specialty designations,
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Hospital Sustainability Demands that Revenue Integrity Move Front and Center
Razor-thin operational margins coupled with substantial and ongoing losses related to COVID-19 are culminating in a perfect storm of bottom-line issues for U.S. hospitals and health systems. A study commissioned by the American Hospital Association (AHA) found that the median hospital margin overall was just 3.5% pre-pandemic, and projected margins will stay in the red for at least half of the nation’s hospitals for the remainder of 2020. The reality is that an increase in
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COVID-19 Underscores Why Certain Aspects of the American Healthcare System Should Change Forever
In the late 1940s, the United Kingdom was busily reassembling country and what remained of the empire in the aftermath of World War II. Among many revelations, the war had convinced Britain’s leaders of the need to provide healthcare for all in the event of calamity upending the basic functions of a civilized society. With that, the UK’s National Health Service (NHS) was born. In 2020, all perspectives about quality and the time it takes to see a provider aside, the NHS remains quite popular
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