The 2015 Employer Health Benefits Survey – What It Means For The Revenue Cycle

Consumer health costs are increasing faster than income while patients continue to be responsible for an even larger share of their healthcare bills. This shift in patient responsibility is having a material impact on provider cash collection that will require new strategies to improve revenue cycle performance.

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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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Four Tools for More Effective Claims Management, Part 1: Predictive Analytics

Predictive models can accurately stratify claims and allow hospitals and health systems to think differently about which accounts to collect (and how) and which to outsource. With these models, you can predict with great confidence which claims are worth very little money, regardless of how much effort is put forth, providing hospitals and health systems with an opportunity to change the claim management paradigm.

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501(r) Q&A Forum Series Part 1: What is expected of hospitals and when?

ICD-10, HITECH, and ACO aren’t the only acronyms clogging healthcare executives’ list of priorities these days. On December 11, 2014, the Consumer Financial Protection Bureau (CFPB) issued a report detailing that 43 million Americans have medical collections on their credit reports. “Getting medical care should not make your credit report sick,” quipped Director Richard Cordray. This report signaled an early and significant focus at the federal level to improve credit report accuracy and eventually lead to the IRS and The Treasury Department releasing the Final Regulations outlining the policies and procedures that providers must follow in the collection of outstanding patient medical balances. Known as Section 501(r) of the Patient Protection and Affordable Care Act (or just, 501(r)), these regulations are extensive and have the attention of healthcare executives and their boards of trustees.

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Are You Prepared to Engage Your Patients?

Providers face a myriad of challenges to the revenue cycle. From shrinking reimbursements and bundled payments to the eventual roll-out of ICD-10, the need to optimize revenue cycle performance continues to increase. But many (if not most) of these challenges impact the well-established relationship that exists between providers-payers. Providers have processes and systems in place to engage commercial and government payers in the claims resolution process (albeit not always optimized). They are much less prepared to turn their focus toward engaging patients in the payment process.

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Connance In The Community: Cradles to Crayons

Connance employees continue to remain active in our surrounding community. Late last year, a member of the Engineering team proposed adopting a charity. Joined by members of the Analytics and Data Management teams, Engineering organized a memorable and rewarding morning last week working at Boston-based Cradles to Crayons. C2C was founded in 2002 with the mission

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2015 HBI Spring Member Retreat – Patient Engagement Takes Center Stage

Revenue cycle executives from across the country competed with the Microsoft Ignite conference for hotel rooms in Chicago, IL, during the HBI 2015 Spring Member Retreat. Attendees representing over 50 organizations came to network with colleagues and hear how they are tackling the biggest challenges of the day. A diverse agenda of presenters covered topics

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