Optimizing Your Revenue Cycle: Applying Analytics

utilization management

Following and understanding industry trends is one of the best ways to improve your revenue cycle. By nature, the healthcare industry is constantly evolving. This means that your revenue strategy won’t stand up to the test of time without optimization and development. The best revenue plan is strict, flexible, and keeps up with industry trends. […]

Improving Hospital Denials by Department

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A hospital’s denial issues vary based on the organization, and because of this, sometimes pinpointing potential denials can be difficult. Moving from a management to a prevention model is a slow process, and issues can potentially arise if denials by department are overlooked. However, the point of denial prevention is to move towards a denial-free […]

Preventing Denials: Root Cause Analysis

Preventing Denials: Root Cause Analysis

The Importance of Root Cause Analysis Root cause analysis is an instrumental part of any revenue integrity program as it aims to prevent denials before they ever happen. Getting down to the root cause of the issue is an—almost—surefire way to avoid the initial denial. Knowing your organization’s specific root causes will allow for faster, […]

3 Things to Look for in a Revenue Integrity Partner

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A revenue integrity partner is necessary for building a broader understanding of organizational claims processes and improvement opportunities. A strategic partner can help decrease time to revenue and reduce administrative costs. Finding and onboarding a partner for your revenue integrity program involve both time and resources, making it important to find the right fit from […]

The Importance of Client Success in Your Revenue Integrity Partner

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Hospitals and health systems seek partnerships that provide solutions to improve revenue integrity. A partner that fosters client success is essential and allows you to manage your revenue cycle more effectively, creating a decreased time-to-money ratio. A sense of urgency, root cause analysis, subject matter expertise, open and consistent communication, and frequent reporting are all […]

The Importance of Technology Solutions From Your Revenue Integrity Partner

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One of the most important elements in a revenue integrity partnership is technology. When considering engaging a revenue integrity partner or optimizing your current strategy, a commitment to technology will be an asset to the revenue integrity management teams.  Healthcare has changed dramatically, even in the last decade, with greater access to technology. Technology enables […]

The Importance of Clinical Expertise in A Revenue Integrity Partner

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When considering engaging a revenue integrity partner, it’s essential to focus on three main components: clinical expertise, the right technology, and proven client success, but for this article, we will focus on clinical expertise. Clinical expertise is critical in solving clinical and coding review challenges. Some important qualifications include:  Having a team of industry veteran […]

Six Common Root Causes of Hospital Claim Denials and Solutions that Increase Your Revenue

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Since 2008, the American Medical Association (AMA) has taken the lead to bring reform to the medical billing and payment system. Even amidst the COVID-19 pandemic, the AMA played a crucial role in shaping the federal response to the omnibus legislative package in December 2020.  While healthcare organizations may still end up with a denial rate of […]

Key Considerations for Outsourcing Your Revenue Cycle

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Hospital systems could risk losing $122 billion in revenue by the end of 2021. The American Hospital Association commissioned a study to examine the effects of the COVID-19 pandemic on hospital revenue. They found that hospital revenue will likely continue declining throughout 2021 to make up for the increase in drug, labor, and supply expenses […]

Revenue Integrity: Analyzing and Reporting

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In the healthcare industry, as with an industry involving business units, it’s common to see gaps form between clinical operations, coding teams, and patient accounting. This is a universal issue and not necessarily the fault of any one system. As a best practice, revenue integrity can be used to bridge some of these naturally occurring […]