For large hospitals and small provider practices alike, healthcare
reform and changing reimbursement models have introduced
significant new challenges to the business. It is now more important
than ever for organizations to have a well-designed revenue cycle
management (RCM) strategy in order to optimize their revenue cycle,
prepare for change, and maximize revenue. At the same time, mergers
and acquisitions among U.S. hospitals and physician practices add to
operational complexity, and with most hospitals employing a wide
vendor portfolio of HCIT solutions, these challenges further the
importance of running a tight financial enterprise. The inability to
effectively monitor and proactively manage the revenue cycle can
destroy profitability and make it difficult to focus on what matters
most — delivering outstanding care to patients.
With improving trends and the need for new investment products, Asset Under Management(AUM) have continued to evolve.
Staying focused on asset allocation and diversification, Mindtree has worked with the leading banks, asset and wealth management firms, superannuation funds for more than 10 years.
P&C Claims Automation Solution - A Competitive AdvantageParagon Solutions
Paragon Solutions, Inc.
Mike Cloutier – Vice President Insurance Markets
http://www.consultparagon.com/industries/insurance/property-and-casualty.html
ACORD Conference May 15-17, 2012
Case Study - MetricStream offers a comprehensive GRC solution that addresses a wide range of health care regulations to reduce the overall cost of compliance management.
Business Continuity Management (BCM) and Continuity of Operations (COOP) is a multi-dimensional practice requiring a balance of investment against risk to the enterprise.
With improving trends and the need for new investment products, Asset Under Management(AUM) have continued to evolve.
Staying focused on asset allocation and diversification, Mindtree has worked with the leading banks, asset and wealth management firms, superannuation funds for more than 10 years.
P&C Claims Automation Solution - A Competitive AdvantageParagon Solutions
Paragon Solutions, Inc.
Mike Cloutier – Vice President Insurance Markets
http://www.consultparagon.com/industries/insurance/property-and-casualty.html
ACORD Conference May 15-17, 2012
Case Study - MetricStream offers a comprehensive GRC solution that addresses a wide range of health care regulations to reduce the overall cost of compliance management.
Business Continuity Management (BCM) and Continuity of Operations (COOP) is a multi-dimensional practice requiring a balance of investment against risk to the enterprise.
SymSure Loan Portfolio Solution
An Innovative continuous controls monitoring solution that tracks any data or transaction and remediates breaches in internal controls. The ideal soultion to prevente revenue loss.
Retail Distribution Review: Preparing Insurance IT for Compliance and Strateg...Cognizant
The Retail Distribution Review offers a significant compliance challenge for UK insurers and advisors. CIOs must prepare by ensuring they have the right enabling technologies to support changing distribution strategies.
Navigant Life Sciences Compliance Sunshine Act Article January 2012saul_helman
Life sciences companies that proactively communicate clear criteria for allocations and the management of reporting of various non-contrac¬tual expenses, as in the example of attendees who eat and attendees who choose not to eat at a dinner program, will be at a distinct advan¬tage in refining internal reporting mechanisms once the Final Rule is published
To keep pace with the ever increasing demand for real-time customer service, shifting to mobility has become inevitable for the insurance industry. In
today's scenario, where real-time servicing of customer requests 'on the fly' has become a norm, mobile technology seems ideally positioned to
enable insurers gain a competitive advantage. Mobile solutions enable faster and improved communications between customers, field agents,
and the central processing office of the insurer.
Adopting mobile technology can help insurers
enhance customers' experiences, increase
productivity, while keeping a check on costs, and
mitigating operational risks.
William F. Zimmerman and Jessy Gene Huebner from The RCC Corp, a solution provider company at the marcus evans National Healthcare CFO Summit Spring 2012, on improving a hospital's revenue cycle through an up-to-date Charge Description Master (CDM).
Interview with: William F. Zimmerman, Chief Executive Officer, and Jessy Gene Huebner, Chief Compliance Officer, The RCC Corp
Defined Benefit Plans Amid Market Volatilitywelshms
For a finance executive confronting volatile market conditions, what's the right balance of risk and return in a defined benefit (DB) pension plan? If you're committed to a DB plan, what strategies can remove excessive risk? Or is it time to refresh your exit strategy?
Towers Perrin and CFO Research Services have completed a study that examines the risk management approaches that finance executives have already taken for their defined benefit pension programs in the United States and Canada. Risk management is clearly "top of mind" for corporate finance executives throughout North America, though risk management solutions may vary widely.
Learn more about the findings and implications of this survey and its relevance to your pension plan as Sylvia Pozezanac, practice leader for Towers Perrin Retirement Risk Solutions, Monica McIntosh, business leader for Towers Perrin Asset Consulting in Canada, and Sam Knox, VP of CFO Research, discuss the findings with a panel.
Discover how our state-of-the-art solutions can optimize your practice's revenue cycle! 🏥💡 Streamline billing, enhance cash flow, and ensure maximum profitability without the headaches.
Our expert team takes care of coding, collections, and more, while you focus on delivering exceptional patient care. Trust us to provide efficient #OpticalRevenueManagement services tailored to your practice's needs.
In today’s environment, Takaful Companies face mounting challenges – stiff competition from the financial services industry; business innovation, regulations, and compliance; and process challenges such as cost containment to return better efficiency and value to stakeholders. In the midst of all these, insurers are increasingly challenged by commoditisation in personal line products, shifting customer requirements, sharp competition, mergers and acquisitions requiring companies’ consolidation, globalisation and economic uncertainties. At the company level, operators are facing increased pressure to minimise risk while maximising growth, improve profitability while reducing turnaround time, improving speed to market of new products, provide positive customer experience, and give good returns on their premiums paid.
Rapid product development is a competitive advantage but now demands much customization to tailor make solutions for each policy owner requiring flexibility, multiple options, and innovations to push information and pull data for analysis or follow ups. These requirements demand business transformation and paradigm shifts. They are a great challenge when there are no structured change management processes, change management tools, automated straight through processes, and a central repository of customer information. Without these, insurers are unable to take the opportunity to capture the market, remain cost competitive, increase profits and retain service excellence. These challenges if not overcome, will be a very real and substantial setback to your plans to pull ahead of your competitors, differentiate yourself in the marketplace and your customers.
By leveraging on our core capabilities and our unique business focus on the insurance industry, AETINS can help you meet these critical needs and unleash your full business potential.
Find out more about our TSF Framework Architecture
SymSure Loan Portfolio Solution
An Innovative continuous controls monitoring solution that tracks any data or transaction and remediates breaches in internal controls. The ideal soultion to prevente revenue loss.
Retail Distribution Review: Preparing Insurance IT for Compliance and Strateg...Cognizant
The Retail Distribution Review offers a significant compliance challenge for UK insurers and advisors. CIOs must prepare by ensuring they have the right enabling technologies to support changing distribution strategies.
Navigant Life Sciences Compliance Sunshine Act Article January 2012saul_helman
Life sciences companies that proactively communicate clear criteria for allocations and the management of reporting of various non-contrac¬tual expenses, as in the example of attendees who eat and attendees who choose not to eat at a dinner program, will be at a distinct advan¬tage in refining internal reporting mechanisms once the Final Rule is published
To keep pace with the ever increasing demand for real-time customer service, shifting to mobility has become inevitable for the insurance industry. In
today's scenario, where real-time servicing of customer requests 'on the fly' has become a norm, mobile technology seems ideally positioned to
enable insurers gain a competitive advantage. Mobile solutions enable faster and improved communications between customers, field agents,
and the central processing office of the insurer.
Adopting mobile technology can help insurers
enhance customers' experiences, increase
productivity, while keeping a check on costs, and
mitigating operational risks.
William F. Zimmerman and Jessy Gene Huebner from The RCC Corp, a solution provider company at the marcus evans National Healthcare CFO Summit Spring 2012, on improving a hospital's revenue cycle through an up-to-date Charge Description Master (CDM).
Interview with: William F. Zimmerman, Chief Executive Officer, and Jessy Gene Huebner, Chief Compliance Officer, The RCC Corp
Defined Benefit Plans Amid Market Volatilitywelshms
For a finance executive confronting volatile market conditions, what's the right balance of risk and return in a defined benefit (DB) pension plan? If you're committed to a DB plan, what strategies can remove excessive risk? Or is it time to refresh your exit strategy?
Towers Perrin and CFO Research Services have completed a study that examines the risk management approaches that finance executives have already taken for their defined benefit pension programs in the United States and Canada. Risk management is clearly "top of mind" for corporate finance executives throughout North America, though risk management solutions may vary widely.
Learn more about the findings and implications of this survey and its relevance to your pension plan as Sylvia Pozezanac, practice leader for Towers Perrin Retirement Risk Solutions, Monica McIntosh, business leader for Towers Perrin Asset Consulting in Canada, and Sam Knox, VP of CFO Research, discuss the findings with a panel.
Discover how our state-of-the-art solutions can optimize your practice's revenue cycle! 🏥💡 Streamline billing, enhance cash flow, and ensure maximum profitability without the headaches.
Our expert team takes care of coding, collections, and more, while you focus on delivering exceptional patient care. Trust us to provide efficient #OpticalRevenueManagement services tailored to your practice's needs.
In today’s environment, Takaful Companies face mounting challenges – stiff competition from the financial services industry; business innovation, regulations, and compliance; and process challenges such as cost containment to return better efficiency and value to stakeholders. In the midst of all these, insurers are increasingly challenged by commoditisation in personal line products, shifting customer requirements, sharp competition, mergers and acquisitions requiring companies’ consolidation, globalisation and economic uncertainties. At the company level, operators are facing increased pressure to minimise risk while maximising growth, improve profitability while reducing turnaround time, improving speed to market of new products, provide positive customer experience, and give good returns on their premiums paid.
Rapid product development is a competitive advantage but now demands much customization to tailor make solutions for each policy owner requiring flexibility, multiple options, and innovations to push information and pull data for analysis or follow ups. These requirements demand business transformation and paradigm shifts. They are a great challenge when there are no structured change management processes, change management tools, automated straight through processes, and a central repository of customer information. Without these, insurers are unable to take the opportunity to capture the market, remain cost competitive, increase profits and retain service excellence. These challenges if not overcome, will be a very real and substantial setback to your plans to pull ahead of your competitors, differentiate yourself in the marketplace and your customers.
By leveraging on our core capabilities and our unique business focus on the insurance industry, AETINS can help you meet these critical needs and unleash your full business potential.
Find out more about our TSF Framework Architecture
Maximizing Revenue, The Key Role of Accounts Receivable & Denial Management i...medkarmamarketing
In the realm of healthcare management, efficient handling of accounts receivable (AR) and denial management stands as a critical pillar for sustaining revenue streams and ensuring the financial health of healthcare providers like Medkarma. As the landscape of medical billing grows increasingly complex, understanding and optimizing these processes become imperative.
Unlocking Efficiency and Boosting Profits_ The Benefits of Outsourcing Revenu...Doctors Back Office
Running a successful healthcare organization requires seamless management of the revenue cycle. From patient registration and billing to claims submission and payment processing, the revenue cycle is a complex and time-consuming process. In today's competitive landscape, healthcare providers are turning to outsourcing revenue cycle management (RCM) to unlock efficiencies and boost profits.
Outsourcing RCM offers numerous benefits. Firstly, it allows healthcare organizations to focus on their core competencies and patient care, while leaving the intricate details of billing and payment processing to experts. This not only improves operational efficiency but also enhances patient satisfaction.
This article seeks to examine a simple but relatively common implementation of a manual expense filing and reimbursement process and using the help of BPM simulation tools, derive some insight into the true costs of managing this process at a small company
From Complexity and Frustration to Simplicity and Effectiveness it is the most viable foundation for discovering new opportunities that build momentum and inspire growth.
Why Revenue Cycle Management Matters For RCM Healthcare Providers.pptMatthew Clark
The healthcare landscape in the United States is undergoing the significant changes, driven by factors such as evolving regulations, increasing patient expectations, and advances in medical technology. In this dynamic environment, healthcare providers are constantly striving to deliver high-quality patient care while maintaining financial stability. One crucial aspect that plays a pivotal role in achieving this delicate balance is revenue cycle management (RCM).
an empirical approach for provider organizations transitioning during healthcare reform implementation, integrating clinical and financial historical experiences. The presentation, Challenge & Response -- delineates the discovery process within experiential databasesA
"Elevate Customer Experiences with Our Solutions"BoddanaAravind
Hey there! We're all about elevating customer experiences with our awesome solutions. The idea is simple - we want to help businesses create unforgettable interactions with their customers. Our top-notch tools and services are designed to make every touchpoint count, from the very first interaction to post-purchase support. Whether it's through personalized recommendations, user-friendly interfaces, or seamless integration across multiple platforms, we've got you covered. Our team of experts is constantly staying ahead of the game, monitoring industry trends and consumer behavior to ensure that our solutions evolve with your customers' needs. So sit back, relax, and let us handle the nitty-gritty of customer experience management while you witness your business blossom into a customer-centric powerhouse!
Although it was considered so terrible it was never going to happen, Sequestration is here. Hospitals are faced with absorbing a 2% reduction in Medicare reimbursement. For some hospitals this can amount to hundreds of thousands of dollars per year. Add to this change Value-based Purchasing, Readmission Penalties, reductions in DSH and UPL payments, increased RAC Reviews and hospitals across the country are facing an uphill climb. This puts a tremendous strain on all hospitals, even those with tax support.
BCBS Affiliate strengthens its Healthcare Compliance through Automation and I...MetricStream Inc
A leading healthcare coverage provider chosen MetricStream’s healthcare compliance solutions to automate and streamline critical compliance workflows, while providing a common platform to integrate compliance management across the enterprise.
Strengthening Financial Performance - Learn how New England Cancer Specialists increased productivity by 36%. Access the complete webinar from within the ppt.
Technical agility for an uncertain future
Uncertainty surrounding legislation, regulatory changes and payment reform bring up a critical question: which IT platform will meet our strategic goals for the future?
The presentation will tell you what a “best-of-breed” really means, and why an interoperable IT strategy will help you effectively navigate the changing healthcare landscape and achieve improved revenue cycle performance.
EMR and Practice Management Replacement 101 - 8 tips to get you started (bt)GE Healthcare - IT
If you are considering replacing your EMR or Practice Management Software, or both, here are some helpful tips to help optimize your investment of time and money. - 8 tips to get you started!
EMR and Practice Management Replacement 101 - 8 tips to get you started (at)GE Healthcare - IT
If you are considering replacing your EMR or Practice Management Software, or both, here are some helpful tips to help optimize your investment of time and money. - 8 tips to get you started!
Smooth transition, strong returns - Dublin Primacy Care Case StudyGE Healthcare - IT
A quick and cost-effective transition from paper to electronic medical records helped Dublin Primary Care streamline staffing, improve care processes, shorten the revenue cycle, and prepare for upcoming payment reform.
The Medical Quality Improvement Consortium from
GE Healthcare is a rapidly growing community of over 500
Centricity* Practice Solution (CPS) and Centricity EMR (CEMR)
customers who contribute de-identified patient clinical data to
a centralized data warehouse to enable quality benchmarking,
Meaningful Use reporting, public health reporting, and research
opportunities. Data from over 25,000 providers and approximately 25 million unique patient records are represented in
the data warehouse today.
Ammonoosuc Community Health Services EMR Medical Record Case StudyGE Healthcare - IT
For Ammonoosuc Community Health Services, an Electronic Medical Record proves essential in delivering award-winning care and achieving Level 3 recognition as a patient-centered medical home
Accountable Care Organizations - Early Lessons Learned from Strong Revenue Cy...GE Healthcare - IT
When the Centers for Medicare and Medicaid (CMS) Innovation
announced plans to select organizations for its Shared Savings
Accountable Care Organization program in April 2011 via a proposed
rule, reactions within the healthcare community were mixed. Some
were excited by the prospect of a push for more coordinated and
integrated care networks, while others criticized the specifics of the
proposal, concerned that the level of provider risk and other provisions
would make the model unsustainable over time. Subsequently, the
Centers for Medicare and Medicaid Services (CMS) issued a Final Rule
on Shared Savings Accountable Care Organizations (ACOs) that was
much more positively received throughout the healthcare community.
CMS then followed the Final Rule with an April 2012 announcement,
adding 27 initial Share Savings ACOs to its original 32 Pioneer ACO
group. With this backdrop in place, it’s clear that accountable care
is more than the latest healthcare buzzword. Today, there is a clear
change in the focus of healthcare providers, with an emphasis on
shifting the focus of payment for hospitals, physicians, and other
healthcare entities towards integrated care and a focus on value and
quality of care rather than the volume of services provided.¹
Healthcare by Any Other Name - Centricity Business WhitepaperGE Healthcare - IT
Whether referred to as integrated healthcare or accountable care, the
current focus on new healthcare models is a reaction to long-standing
concerns around quality, cost, and efficiency. Many of these issues stem
from care delivery systems that have been:
• Directed more at episodic treatment than prevention and early intervention
• Fragmented rather than integrated and coordinated
• Focused on patient eligibility and billing rather than patient engagement
within and outside of the care setting
• Customized to the idiosyncrasies of individual facilities rather than
standardized across care sites
• Rewarded more for volume than for quality and cost outcomes
The resulting inefficiencies have made healthcare less effective, less safe,
and more costly than can be tolerated, particularly against the backdrop of
a challenging worldwide economy. The old dictum ‘if you provide healthcare,
they will pay’ no longer applies. Public payers, private payers, and regulatory
agencies are wielding both carrots and sticks to drive healthcare organizations
toward greater coordination, demonstrable quality, and measurable
cost control.
The consensus on what ails our health systems, as well as the availability
of new technologies, has led to the creation of new models of delivery,
such accountable care organizations and integrated health organizations.
By whatever name, these healthcare models are designed to promote
accountability and improve outcomes for the health of a defined population.
The Need to Embrace Profit Cycle Management in Healthcare - WhitepaperGE Healthcare - IT
Executive Overview
Healthcare organizations have been operating under a fee-for-service
model for many years. As such, financial leaders have become well
versed in implementing revenue cycle management systems and
processes that primarily focus on the money that comes into an
organization. Today, a new need is emerging. Healthcare reform
and other system changes are moving the industry toward hybrid
payment models such as bundled payments, shared savings, and
capitation. To thrive in this new environment, financial leaders need
to move toward profit cycle management – an emerging model
that matches the revenues from new payment models with an
improved understanding of the true costs to deliver patient care.
The result: Positive financial performance – even in the face of
declining payments – that can be reinvested in the mission to
provide better care.
The foundation of any business or household is profit, defined as
revenue net of expenses (and applicable as such even to not-for-profit
organizations). Regardless of whether you are start-up, a Fortune 500
company, or a family of four, you need to ensure that you are bringing
in more money than you are spending. In many businesses, the
formula to determine your “profitability” is fairly straightforward.
In healthcare, however, the situation is significantly more complex,
as existing and new payment models make it difficult to determine
exactly how much revenue is going to come in the door. On the cost
side, the move to accountable care and value-based payment has
shifted the management of risk and cost onto the providers and
delivery networks, yet most providers lack the tools that would
provide a detailed understanding of the costs required to deliver
quality care, especially when that care is delivered in multiple
locations. A new model of software tools is required – representing
the next generation of revenue cycle management tools and an
emerging class of healthcare cost accounting tools. The end goal?
A solution for profit cycle management that will help organizations
generate a positive financial performance and can be reinvested
in the mission to provide better care.
This change will not happen overnight. Rather, it will be an evolution
over the next five years, as integrated delivery networks update
their revenue cycle solutions to accommodate the new payment
models, and as they deploy new activity-based costing solutions.
Proven revenue cycle management supporting profitability in an era of healthcare reform.
Profitability, efficiency, and enhanced quality of care
A proven, next-generation healthcare revenue cycle management solution that supports traditional and accountable care reimbursement models, Centricity* Business delivers proven revenue cycle
performance.
Electronic data interchange and proactive services for Centricity revenue cycle management customers.
Centricity EDI Services combines revenue cycle expertise and proven
services to help speed up the revenue cycle and increase productivity. Proactive
monitoring and support help to detect payer issues — often before you even realize
there’s a problem.
Key features
• Tight alignment with payers ensures mandates, updates and other payer-specific adjustments are addressed and communicated
• Management of payer connections and ownership of payer issue resolution
• Web-based tracking and reporting of all pertinent data, including transaction volumes, file and claim levels, rejection highlights, and rejection details
• Best-practice workflows and automated task management to streamline follow-up
• Notification of changes in payer processing to ensure continuous transactions
Optimizing Revenue Cycle Management: Centricity Business at Saint Francis Health System
1. Optimizing Revenue Cycle Management:
A Case Study of Centricity Business at
Saint Francis Health System
WHITE PAPER
Sponsored by: GE Healthcare
J u d y H an ov e r E r ic N ew ma r k
Au gus t 2 012
www.idc-hi.com
IDC HEALTH INSIGHTS OPINION
For large hospitals and small provider practices alike, healthcare
F.508.988.7881
reform and changing reimbursement models have introduced
significant new challenges to the business. It is now more important
than ever for organizations to have a well-designed revenue cycle
management (RCM) strategy in order to optimize their revenue cycle,
prepare for change, and maximize revenue. At the same time, mergers
P.508.935.4445
and acquisitions among U.S. hospitals and physician practices add to
operational complexity, and with most hospitals employing a wide
vendor portfolio of HCIT solutions, these challenges further the
importance of running a tight financial enterprise. The inability to
effectively monitor and proactively manage the revenue cycle can
Global Headquarters: 5 Speen Street Framingham, MA 01701 USA
destroy profitability and make it difficult to focus on what matters
most — delivering outstanding care to patients.
Poor management of the revenue cycle can destroy profit margins,
damage payer relationships, and lead to an inability to cover overhead
costs. Without adequate funding to invest in innovative technologies
and maintain competitive levels of physician compensation, practices
can become quickly immersed in a downward spiral. Countering these
business risks with a well-designed RCM software solution has
become a critical stratagem for most provider organizations.
Situation Overview
An increasing population of self-pay patients and patients with high
deductible insurance plans, coupled with growing levels of
unrecoverable debt from the uninsured, has helped catapult RCM
software to the front lines of the provider battle against profitability and
margin erosion. RCM software assists and optimizes cross-discipline
administrative functions to help ensure that provider organizations
collect all money owed to them for services rendered. The revenue cycle,
which begins when a patient first makes contact to schedule an
appointment and ends when all payments for services performed have
been received, can be viewed as the financial circulatory system of
August 2012, IDC Health Insights #HI236381