The Hidden Costs of Claim Denials

Beyond the obvious delays in payment for services rendered, there are many other ways that denials are hurting your revenue cycle performance. The Medical Group Management Association (MGMA) recommends that a medical practice should shoot for a 95% or higher clean claims rate. The reality is that most practices struggle to even get close to […]

Best Practices for Increasing Patient Responsibility Collections

Patients are being increasingly held responsible for larger portions of their healthcare bills. Find out ways that healthcare organizations can navigate this challenge in the face of increasing economic pressure. Why is Patient Responsibility on the Rise? A large portion of the revenue cycle is concerned with billing and insurance claims to receive money from […]

The Importance of Maintaining a Strong Credentialing Program

Credentialing is a critical process that ensures only safe and qualified caregivers are verified and hired. Without robust processes, your organization could be at heightened risk. Credentialing of physicians and other clinicians is a process that often happens in the background, without receiving much attention until something goes wrong. This careful process of collecting documentation […]

Watch out for These Prior Authorization Pitfalls

Missing a prior authorization can mean costly claims denials. However, prior authorizations are more complicated than ever – learn the info you need to stay on top of the issues in 2023.  Insurance prior authorizations are a topic of contention between the provider and payer sides of the healthcare ecosystem. Healthcare payers – both government […]

Revenue Challenges – E/M Code Capture and Medical Decision Making

The CPT E/M (evaluation and management) coding system underwent some additional changes that became effective on January 1, 2023. If you are seeing revenue changes from the ED, this may be the reason. Changes to the E/M coding system don’t just mean that the coding department needs education and updates – clinicians need to be […]

Technology that Disrupts the Nursing Shortage

Way back in 2020 (seems like so long ago, right?) Forbes was hailing the importance of using nurse staffing technology to combat the pending nursing shortage. I think it is safe to say that we are here. After a physically and mentally destructive pandemic, the nursing profession has emerged even more battered and bruised than […]

Not Just Nursing – Workforce Shortages Across Healthcare

While nursing shortages are certainly front and center and are covered extensively by the media, hospitals are also suffering from a shortage of all types of workers, from entry-level on up.  As the U.S. gradually reaches a state of recovery after the pandemic, healthcare worker shortages across the board are becoming more apparent. While the […]

What Do Nurses Want (and Need)?

In the wake of some of the largest organized labor strikes in recent years, the nursing profession is struggling. What is needed to start down the road to improvement? More than 7,000 nurses in New York City walked off the job this month, with complaints that might surprise you. Pay was NOT at the forefront […]

Nursing Shortages in the Workforce: The Next National Emergency?

We all knew it was coming – but the shortage of healthcare workers is quickly becoming worse than predicted. Let’s look at industry trends to better understand the post-pandemic 2023 healthcare landscape. In a March 2022 letter to the House Energy and Commerce Committee, the American Hospital Association declared the workforce shortage in hospitals a […]

4 Ways to Keep Your Remote RCM Staff Engaged

Many RCM staff are staying remote, but they are still an integral part of the team. Learn how to keep ALL staff engaged and moving towards revenue cycle goals. So, you have a remote or hybrid RCM workforce, which is great – but how do you keep everyone in the loop and driving towards the […]