Reimbursement Challenges In The Healthcare Industry

Decent Essays
Getting paid quickly and correctly relies on accurately translating the language of clinical care into the dialect of payment for services. The strength of your revenue cycle performance relies on your focus on coding, documentation of the clinical care rendered, and compliance. Persistent problems in these areas can cost your organization millions of dollars annually in lost revenue. And it’s only getting worse with the onset of ICD10!

As the leading provider of software solutions for reimbursement challenges in the healthcare industry, our solutions impact thousands of clients and tens of millions of lives globally. Our core competency and sole focus of our solutions is Compliance and Claims Accuracy. With 100+ data files, we are your

Related Documents

  • Improved Essays

    Hcr 220 Week 9 Rcm

    • 443 Words
    • 2 Pages

    RCM unifies the clinical and business side of healthcare using both primary and secondary patient data, insurance, and provider and the revenue cycle is vital in creating compliant and efficient reimbursement processes. The revenue cycle is divided into four which are preclaims activities, claims processing, account receivable and claims reconciliation and collection. The preclaims submission is the first process in the cycle which begins with patient case management and preregistration such as collection insurance information before patient arrives then collecting subsequent patient information to create a medical record number to meet financial, clinical and regulatory requirement and Medicare patient are advised on financial responsibilities if…

    • 443 Words
    • 2 Pages
    Improved Essays
  • Improved Essays

    ICD-10 (Icd-9)

    • 715 Words
    • 3 Pages

    Well, whether your office is ready or not, ICD-10-CM is coming. While its implementation has been delayed over the past few years, it's not going away. This update is more complicated than the ICD-9-CM. Things change. Diagnosis and treatment both have gotten more complicated in the past 25 years since the ICD-9 was introduced.…

    • 715 Words
    • 3 Pages
    Improved Essays
  • Improved Essays

    ICD-10 billing will be a valued skill that no outpatient practice can afford to be without. Once the new system goes into effect, there will not be time to catch up. One day, we will billing with ICD-9. After midnight, we will be billing with ICD-10. Anyone who has not mastered ICD-10 is going to lose revenue.…

    • 622 Words
    • 3 Pages
    Improved Essays
  • Improved Essays

    Nurse practitioner reimbursement is a complex configuration that includes regulatory factors both at the state and federal levels. As late as 1990, direct Advanced Practice Registered Nurse’s (APRN) reimbursement by Medicare was available only in rural areas and skilled nursing facilities (1). In 1997, President Clinton instituted the Balance Budget Act that expanded the reimbursement for APRN’s to all geographical and clinical settings allowing the direct Medicare reimbursement to NP’s, but at 85% of the physician reimbursement rate (2). Although the expansion of nurse practitioners scope of practice was intended to meet the needs of a shortage of family physicians, it has left gaps in care for many of the most defenseless populations.…

    • 113 Words
    • 1 Pages
    Improved Essays
  • Great Essays

    Health care payments favor the provider rather than the care that is given to the patients. Hospitals provide more care regardless of the outcome they have on the patient. Examples of this are unnecessary tests, medication, and treatment. Modernizing the payment structure is an important part of the AHCCCS goals. Some of the strategies that the AHCCCS are providing patients and providers incentives to encourage collaboration, change the way care is delivered, improve performance by rewarding innovation and results, payment for the care outcome rather than the quantity of care, and boost collaboration in learning (Welcome to Arizona Health Care Cost Containment System (AHCCCS), 2016).…

    • 1164 Words
    • 5 Pages
    Great Essays
  • Improved Essays

    What are two issues of physician reimbursement some are the practice expenses, doctor’s income and the reimbursement rates. The physician reimbursement is what the insurance company paid your physician for his services. Physicians cannot negotiate with the insurance company about the cost. Managed care organizations are trying to control the cost of health care but it’s not working.…

    • 693 Words
    • 3 Pages
    Improved Essays
  • Great Essays

    Introduction The goals of the Patient Protection and Affordable Care Act (ACA) has propelled all primary care practices into new and uncharted territory. To meet the primary goals of the ACA, primary care physicians would play a pivotal role in improving the health of Americans and lowering the costs of the health care they receive. The legislation plans to accomplish this by moving from fee-for-service to value-based reimbursement. The value of the value-based reimbursement is based on improving the quality of care as demonstrated by improved quality measures.…

    • 1109 Words
    • 5 Pages
    Great Essays
  • Improved Essays

    Financial trends and reimbursement changes go hand-in-hand. Healing Hands Hospital relies on revenue from managed care reimbursements, therefore any changes within the managed care system will affect our financial budgets and income. This will affect how we pay our employees and what kind of services we are able to provide. It has major influence on how we deliver and pay for health care products and services.…

    • 1002 Words
    • 5 Pages
    Improved Essays
  • Improved Essays

    Value Based Reimbursement

    • 694 Words
    • 3 Pages

    Making value-based healthcare work for patients and providers is challenging, but worth the effort. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), is designed to encourage more medical providers, specifically physician practices, embrace value-based health services. The new rule enacted in 2015 modifies electronic health record (EHR) Meaningful Use reimbursement guidelines. Larry Kocot, national leader of KPMG's Center for Healthcare Regulatory Insight, told Physicians Practice, although the CEHRT systems standards are optional for 2017, all MU participants will be required to meet performance expectations beginning in 2018.…

    • 694 Words
    • 3 Pages
    Improved Essays
  • Improved Essays

    Concerns about cost have led to the popularity of managed care options, first by corporations for their employees and now by governments, through the Medicare and Medicaid programs. Despite recent federal budget surpluses and proposals to expand funding and benefits in Medicare, there is serious concern among economists, legislators, and bureaucrats about the long-term solvency of both publicly funded programs. Concerns about cost are present in every form of nursing practice; they affect how work is organized, treatment plans for patients, and patients' perceptions of and participation in care. For example, even individuals with health insurance are wary of increased out-of-pocket expenses and no covered services. And there is heightened concern about pharmaceutical costs, fueled, in part, by the development of sophisticated new drugs.…

    • 403 Words
    • 2 Pages
    Improved Essays
  • Improved Essays

    Part I: Medicaid Reimbursement: Cost of Patient In the healthcare industry, everything is expensive; from medication, technology, and treatments that cost from hundreds to thousands of dollars. This have caused a stressful mental breakdown and burden by the charges and bills. For example, my mom surgery cost $25,000 total; surgery, medication, and three night stay at the hospital. Medicaid and its’ reimbursement program have cover majority of the bill.…

    • 658 Words
    • 3 Pages
    Improved Essays
  • Superior Essays

    Reimbursement and quality, improvement in long term care systems, Medicaid has complained about reimbursements have been lower and if they become lower than quality car would suffer. However, if states set Medicaid nursing home reimbursement levels and the federal government make changes also think the quality of care will come down or suffer. The withdrawal of services will affect quality, if they are not covered or no longer funded than these services will no longer be provided. It seems that no matter what the reimbursement levels are it does not affect the quality of care given by the staff.…

    • 1287 Words
    • 6 Pages
    Superior Essays
  • Improved Essays

    Get Well Clinic Analysis

    • 953 Words
    • 4 Pages

    The evaluation of an organization is a task that often presents with its own set of challenges. Despite this, the evaluation should be as comprehensive and accurate as possible, especially when considering the impact it has upon the lives of others. The following is the analysis of a healthcare organization known as the Get Well Clinic (GWC). Our evaluation of GWC utilizes a framework-based perspective that outlines both findings and suggestions for improvement. First, we examine GWC’s structural frame to assess rules, policies, and goals (Bolman & Deal, 2013).…

    • 953 Words
    • 4 Pages
    Improved Essays
  • Improved Essays

    There are several business principles related to patient and system costs in health care that are needed to maintain safe, quality, patient-centered care that is fiscally sound. For this discussion, I will put myself in the shoes of a nurse manager, director of nursing, Chief Nursing Officer, or business owner and consider three of the principles from the Greg Fisher Power Point (2008). The principles I will examine are: 1) decide what makes you different; 2) manage employees; and 3) set goals. The reason why I selected these three business principles is that they appear to me to be a good place to start the groundwork for any business model, including the field of health care.…

    • 893 Words
    • 4 Pages
    Improved Essays
  • Improved Essays

    The need to control healthcare cost remains a major goal of all stakeholders in the nation. The predicament Lake County Medical (LCM) finds itself in is typical with healthcare providers currently; declining Medicare reimbursement and an uptick in Medicare & Medicaid beneficiaries (Shi & Singh, 2015). An 11% decrease in reimbursement rate equating to $5.8 million reduction in revenue threatens LCM’s viability. The need for creativity is needed for this organization. Tactical objectives are a twofold; revenue-generating strategies and cost-cutting efforts (Herman, 2012).…

    • 788 Words
    • 4 Pages
    Improved Essays