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HFMA Western Region Symposium 2025: Three Key Takeaways

2025-02-21T21:48:21-05:00

Now that the dust has settled, the LinkedIn connections finalized, and the minds expanded, let’s review our key thoughts from this year’s HFMA Western Region Symposium. AI Continues to be at the ForefrontStroll through the Vendor booths of the Symposium and you’ll notice that most are pedaling AI in some way, shape, or form. AI has been top of mind since ChatGPT took the world by storm in November 2022. Automation has been [...]

HFMA Western Region Symposium 2025: Three Key Takeaways2025-02-21T21:48:21-05:00

The Critical Role of a Comprehensive Revenue Cycle Assessment Before an Epic Implementation

2025-02-16T20:47:09-05:00

Implementing Epic is a significant transformation for any healthcare organization. While the platform offers unparalleled capabilities in revenue cycle management, failing to conduct a thorough revenue cycle assessment of your current state before beginning the implementation journey may lead to operational disruptions, financial instability, and missed improvement opportunities. By proactively evaluating existing legacy processes, leadership structures, financial opportunities, and current system integrations (both bolt-on and process partners), organizations can streamline implementation and position [...]

The Critical Role of a Comprehensive Revenue Cycle Assessment Before an Epic Implementation2025-02-16T20:47:09-05:00

The Power of the Unknown: Leveraging AI to Aid Your Revenue Cycle Practice

2024-12-12T10:40:43-05:00

Let me start by saying that while AI (Artificial Intelligence) has been hailed as a game-changer, I approach it with a fair degree of skepticism. It is easy to be swept away by the hype, but AI is a tool that brings several pitfalls. Misinformation is a common byproduct of AI systems, and, without proper oversight, they can easily go awry. The technology often falls short of the grand claims made about [...]

The Power of the Unknown: Leveraging AI to Aid Your Revenue Cycle Practice2024-12-12T10:40:43-05:00

Emerging Payment Models: Value-Based Care and its Impact on Revenue Cycle

2024-09-26T07:30:01-04:00

OverviewOver the past several years, hospitals and health systems have continued to face significant challenges such as rising inflation and staff shortages. These issues have strained many providers' missions to deliver high-quality health care. Emerging payment models, particularly Value-Based Care (VBC), are at the forefront of ensuring positive patient outcomes while addressing these challenges.Opportunities and ConsiderationsValue-Based Care represents a paradigm shift in healthcare reimbursement, moving away from the conventional fee-for-service model towards [...]

Emerging Payment Models: Value-Based Care and its Impact on Revenue Cycle2024-09-26T07:30:01-04:00

Designing and Calculating Your System’s Denial Rate

2024-06-28T18:40:40-04:00

As electronic health records systems and vendor tools have become more and more sophisticated, a myriad of metrics and KPIs are readily available to health systems with the click of a button. Some executive scorecards can have upwards of 20-30 metrics for ongoing reporting! A system’s denial rate is typically one of these metrics but is usually not one that is fully understood due to the complexity of denials data.Since denials touch [...]

Designing and Calculating Your System’s Denial Rate2024-06-28T18:40:40-04:00

Bringing Transparency to Epic Hospital Billing

2024-04-22T21:43:49-04:00

All too often, when ramping up at a new Epic client, PinnacleHCA consultants find ourselves sifting through Excel-based dashboards to validate data, trends, or issues. Additionally, it is not uncommon for a CFO, Director of Revenue Cycle, or functional Team Lead to approach us with questions around how to track down specific account populations for projects such as a Medicare audit or rebill initiative.Epic comes with many bells and whistles that allow [...]

Bringing Transparency to Epic Hospital Billing2024-04-22T21:43:49-04:00

Key Considerations for Legacy AR Rundown Strategy

2024-06-28T18:47:08-04:00

OverviewSystem conversions necessitate extensive planning, design, resource commitment, and resource alignment. One of the key components of a successful conversion that sometimes gets underestimated or overlooked is the strategy for the legacy system accounts receivable (AR).  One of the first decisions likely to be considered when evaluating your legacy AR is the idea of conversion vs. pursuing an AR rundown strategy. This decision is likely evaluated around the criteria of legacy process and [...]

Key Considerations for Legacy AR Rundown Strategy2024-06-28T18:47:08-04:00

Patient Access: Opening the Front Door to the Revenue Cycle

2024-04-01T11:39:49-04:00

After 20 years working in all facets of the revenue cycle, I still believe that providing additional support and pay parity to Patient Access is where we need to focus more of our time, energy, and resources. Patient Access is truly our front door into our clinics and hospitals and the way into all other departments.Access employees are often the first impression makers for our patients and their families. As the first [...]

Patient Access: Opening the Front Door to the Revenue Cycle2024-04-01T11:39:49-04:00

Epic PB: Understanding and Improving Your Pre-AR (and the “Pre” Pre-AR You May Not Even Know About)

2024-02-14T06:54:59-05:00

Epic Pre-AR equates to unposted charges that are held in Charge Review work queues (WQs). Fluctuations in Pre-AR are common yet can have a significant impact on your actual AR days, gross revenue, cash flow, visit statistics, provider productivity/compensation, and even patient care if providers do not complete critical documentation and close encounters in a timely manner. In the most ideal world, clinic charges are documented, coded, and posted the same day the service [...]

Epic PB: Understanding and Improving Your Pre-AR (and the “Pre” Pre-AR You May Not Even Know About)2024-02-14T06:54:59-05:00

An Integrated Approach to a Case Management Denial Prevention Program

2024-06-28T23:09:08-04:00

Case Management (CM) plays a pivotal role in ensuring the Revenue Cycle (RC) operates efficiently and effectively by improving patient care and patient relationships, reducing denials, and enhancing the organization’s overall financial performance. Within the denial reduction scope, an effective Case Management department can pre-emptively address encounters that have a higher likelihood of medical necessity denials to ensure streamlined compensation.  According to Change Healthcare, their research shows nationally that medical necessity denials [...]

An Integrated Approach to a Case Management Denial Prevention Program2024-06-28T23:09:08-04:00
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