A recent Managed Healthcare Executive magazine article entitled: “Five ways to reduce healthcare administrative costs,” identifies five strategies that healthcare executives can use to reduce onerous administrative costs. According to the article, administrative costs make up about 15 percent of all healthcare expenditures -- well over $300 billion annually, as found in the 2016 index report from the California Association for Healthcare Quality. Outdated, manual processes and rejected claims eat up a large portion of this administrative cost.
Medicare Advantage (MA) is a complex program that continues to gain popularity, with about one-third of Medicare beneficiaries currently enrolled in a variety of MA programs. MA plans are issued by MAOs, or Medicare Advantage Organizations, that are typically insurance companies.
Not only is clinical documentation improvement (CDI) the key to better ICD-10 coding and reimbursement accuracy, but it's also vital for preparing healthcare organizations for the new care paradigm of population health management. To this end, AHIMA has designated the month of July as CDI Month with Aviacode joining in the recognition to CDI professionals nationwide.
There are two key players in revenue cycle stream – the HIM coding department and the patient financial services department. Working together these two departments can sustain a healthy revenue cycle for any healthcare organization. These two departments are responsible for all of the basic elements of the revenue cycle -- from registration to coding the care provided to final discharge.
Patient financial services, typically, includes the registration process, and that is where the revenue stream has its head waters. An accurate registration process establishes the basis for future follow-up with payers or the patient as a self-payer.
Using their knowledge of billing rules, patient financial services applies the appropriate billing rules, such as Local Medical Review Policies (LMRPs) or National Coverage Determinations (NCDs) to produce an accurate patient bill.
The HIM coding department uses its vast knowledge of the very latest coding rules to provide patient financial services with an accurate medical record from which to produce their patient bill.