Posts By: Connance

Doing More with Less, The Value of Automated Claims Status Reporting

Automating claims statusing takes the manual and tedious and helps focus precious resources on claims that matter. Still, it’s not just THE solution to transform hospital business offices. It’s A sophisticated tool forward-thinking hospitals should have in their business office tool kit, to maximize productivity and achieve the revenue cycle results necessary to continue to offer excellent healthcare.

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Population Health Initiatives Need to Take a More Holistic Approach

The ability to approach population health initiatives requires a holistic view of individual patients, the context of their community environment and the barriers that prevent access to resources. Continued, “siloed” use of claims and clinical data without socio-demographic and behavioral insight to define targeted patient populations will only provide a superficial view of those in need of strategic interventions.

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Do you have what it takes for successful patient engagement?

Never before has engaging patients been so critical to the growth and sustainability of healthcare providers and organizations. Whether the goal of patient engagement is to manage the health of a population, maximize patient satisfaction and loyalty, or transition to value-based care, providers cannot underestimate the power of actively identifying socio-demographic attributes of their patient populations.

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10 Things to Consider When Evaluating Propensity to Pay Scoring Solutions

The continued increase in revenue from self-pay as a percentage of total net patient revenue is forcing business offices to look for new and smarter ways to prioritize accounts and engage patients in the collection process. A common approach, often referred to as “propensity-to-pay,” involves scoring accounts based on their likelihood to pay. But not

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The Laborious Task of Vendor Management

Hospitals and health systems have begun contracting with more and more collection agencies and other vendors to cope with a growing list of revenue cycle challenges. Still others would like to employ more (or change existing) agencies but for the effort associated with vendor selection, file integration, and performance monitoring and management. These and other labor-intensive processes can benefit from a vendor management platform that increases visibility, collaboration, and control over your outsourced relationships.

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A Credit Score Caution

A Common approach to prioritizing self-pay collection efforts borrows from the claims collection process – focusing resources first on high-balance accounts. But many high-balance accounts are less likely to pay and require more effort to resolve than low-balance accounts. This has led some organizations to begin using “propensity-to-pay” scores as a way of prioritizing resources and making smarter decisions about how to collect from patients. The most common propensity-to-pay scores are calculated using credit bureau data. This approach has significant downside that providers should consider.

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The Epic Transformation of Case Managers

As I review my notes from the conference speakers and poster sessions, I realize the tremendous but evolving role case managers continue to play throughout the healthcare system. Advocating for and guiding patients through the healthcare maze has always been a core strength of ours, but now we are expected to apply our skills toward even more targeted goals like reducing readmission risk, improving outcomes, and improving an organization’s bottom line under value-based payments. As healthcare delivery continues to evolve, so does the role of case management in these new care models.

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Four Tools for More Effective Claims Management, Part 4: Activity Monitoring & Reporting

Predictive analytics help answer important questions about what will happen in the future that might cause you to do something differently. But there’s still another important tool for effective claims management that allows revenue cycle teams to determine the most effective follow-up pathways, and manage and improve performance over time – namely, account-level activity monitoring and reporting.

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501(r) Q&A Forum Series, Part 2: What Are the Risks of Using Scoring?

What are the risks of using scoring to determine presumptive eligibility for financial assistance? The biggest risks of using scoring to determine presumptive eligibility for financial assistance are if your scoring process is not adequately described in your Financial Assistance Policy (FAP) or if you are using scoring in a way that’s inconsistent with your policy.

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Four Tools for More Effective Claims Management, Part 2: Automated Statusing

Today’s typical claims follow-up process degrades financial performance. One area in particular that drains valuable resources and lengthens the revenue to cash conversion involves the process of checking the status of a claim. This typically manual process requires significant staff time with a surprisingly low return. Roughly 80% of claim statusing efforts are on claims which are due to be paid anyway. But how do you know which claims to status, when, and how often? And what will you do with the status information when you acquire it? How will it increase the likelihood, speed and amount of cash you collect?

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