Changes coming in 2021 2020 looks to be a transition year on the payment front, as many programs and changes expected to go into effect this year have been delayed until 2021. These include new CMS-created primary care models and a streamlining of evaluation and management level-of-care coding. CMS announced in October its newest alternative […]
Clean Claim Rate (CCR) and First Pass Rate (FPR)
Two metrics important to the discussion of creating claims most likely to be immediately reimbursable are Clean Claim Rate (CCR) and First Pass Rate (FPR). Though sometimes confused for one another, these are separate statistics, each worthy of optimization. HFMA identifies the value of CCR as an indicator of the quality of data collected and reported. […]
EAPG
Blue Cross Blue Shield Enhanced Ambulatory Patient Grouping (EAPG) methodology for calculating reimbursement for outpatient procedures http://www.okoha.com/OHA/Hotline/2015/April15/Taking_charge_of_the_EAPG__Improve_your_negotiations_with_BCBS.aspx
Hospitals typically leaving $22M on the table
Read this report from the Advisory Board on ways you can improve revenue cycle performance now. Hospitals leaving $22M on the table
Core Quality Measures
Overview There is a great demand today for accurate, useful information on health care quality that can inform the decisions of consumers, employers, physicians and other clinicians, and policymakers. This is increasingly important as the health care system moves towards value-based reimbursement models. It is difficult to have actionable and useful information because physicians and […]
HFMA MAP Keys
KPI’s from HFMA MAP Keys program MAP Keys are industry-standard metrics or KPIs usedto track your organization’s revenue cycle performance usingobjective, consistent calculations. http://www.hfma.org/MAP/mapkeys/ map-award-tables_061616-2
Making RVUs Work for Your Medical Practice
Resource -Based RVU defined July 01, 2014 Linked Articles The Basics of Making RVUs Work for Your Medical Practice RVUs Remain a Relevant System to Determine Physician Compensation Assigning RVU Values to Procedures That Don’t Have Them Using RVUs to Measure Physician Performance Calculate Your RVU Payment Cost Accounting in the Medical Practice via RVU […]
Developing Financial Assistance Policies with the Latest IRS Rules in Mind
http://www.hfma.org/Content.aspx?id=32027#.VgNfflVcR_w.mailto Financial assistance programs IRS rules on hospital FAP’s
Using KPIs to Accelerate Revenue Cycle Performance
Click to access PNC%20SW%20Ohio%20HFMA%20Presentation.pdf Using KPIs to Accelerate Revenue Cycle Performance Click to access PNC%20SW%20Ohio%20HFMA%20Presentation.pdf Measurement • We’ve all heard it: you can’t manage what you don’t measure. – Measurement aids in identifying problem areas. – Sets the stage for setting goals/targets and working toward them. • It is also a proven principle that: – […]
Office of Medicare Hearings and Appeals (OMHA)
With the two midnight rule becoming effective, this website is a good resource for information. Office of Medicare Hearings and Appeals (OMHA) OMHA administers appeal hearings for the Medicare program. There are five levels in the Medicare claims appeal process. OMHA’s Administrative Law Judges hold hearings and issue decisions related to Medicare coverage […]
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