BHM Services
The healthcare revenue cycle management environment is ever-changing, but continued advances in technology help healthcare professionals be more effective and efficient during each step of the process. Thanks to new software, increased portability, and a transition to electronic health records, ease of use is increasing swiftly.
Unless you’re a psychiatrist or psychiatric nurse, you may not remember that Psychology 101 course you took in medical school, but if you want to improve patient satisfaction, you might want to revisit it. When we focus on medicine as being an entirely “hard science” and we focus on test results, data and what we can palpate or visualize, we are leaving out a very important facet of the patient’s healthcare experience - feelings.
For most healthcare systems, the ongoing dilemmas surrounding streamlining emergency room services are some of the most challenging in the industry today. Since ER’s can really make or break hospital’s patient satisfaction scores, and therefore, reimbursement, tackling these challenges sooner rather than later is probably in the best interest of most hospitals - one Florida hospital has already completely overhauled the concept of emergency room care through clinical operations and is now setting a high bar for ERs around the country.
In the wake of Ebola, healthcare systems worldwide are focusing more than ever on defining - and refining - their population health initiatives. Smart thinking on multiple accounts, if you think about where we’re headed in terms of healthcare reform. Hospitals that are moving towards population health initiatives now will be far better prepared for the overall shift to accountable care that’s on the horizon.
When we think of costly health conditions, the first that comes to mind for many is cancer. Treatment costs alone can bottom out even the best insurance plans. But did you know that behavior health conditions cost just as much per year as cancer? At a whopping $57 million per year, behavioral health conditions are one of the most costly health conditions in the United States today. While behavioral health conditions are rampant, they often don’t get as much attention as their more physical counterparts. Research tells us that mental health woes like anxiety and depression can greatly worsen, or at the very least contribute to, chronic pain conditions and even affect the length of our lives - but these conditions are often not diagnosed and treated effectively, or, in conjunction with the other comorbidities of a particular patient with complex health needs.
When we look at the fee-for-service model from only one perspective, it’s easy to condemn it as “the reason” healthcare spending has spiraled out of control. When it comes to how providers bill for services, having the ability to bill for anything and everything could, and certainly did, encourage the ordering of too many tests and procedures, even unnecessary ones. The idea of value-based payment models not only encourages providers to make more mindful choices, but cost-effective ones too. It also challenges healthcare systems, pharmaceutical companies and patients to be even more vigilant about healthcare costs. Fees are relative to each party involved.
Are you confused about ACOs - what they are, how they function, what their purpose is? We have all heard the term ACO and most of us know that stands for Accountable Care Organization. Stretching past these basics, the waters become a bit more muddied. So what is an ACO and how does it work? Do you have 6 minutes? Following is a great video created by OSF Healthcare. The video gives a great overview of what an ACO is as well as the goals. Some of the highlights include:
The Centers for Medicare & Medicaid Services (CMS) released a new set of quality and financial performance findings on September 16, 2014. These findings showed Medicare Accountable Care Organizations had elevated the quality of care for recipients through preventative health initiatives and collaborative efforts between doctors, hospitals, and care providers.
The Medical Group Management Association actually put a price tag on the cost of managing each denial in your organization’s denial queue: $25-$30 a piece. That cost adds up when you consider that up to as many as a quarter of all claims get denied - meaning that for some hospitals, that $25 per claim price tag could become overwhelming pretty quickly. The first step in the case of any denied claim is determining why it was denied.
Peer review and quality. Healthcare is an industry that perhaps has even surpassed car manufacturing in concern with quality measures. And it should be. After all, we’re dealing with human beings, not cars. Peer review often concerns itself with peering closely at quality measures, compliance and safety. Patients are already vulnerable when they enter the hospital, due to illness or injury, so it is everyone’s concern in healthcare to be mindful of what areas of weakness within an organization could be influencing patient outcomes in a negative way.