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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

Navigating Net Revenue and Revenue Cycle Performance: Strategies for Alignment

2023-12-21T12:24:26-05:00

In the intricate dance of healthcare financial management, the connection between Net Revenue and Revenue Cycle performance is often overlooked or misunderstood. Finance teams may wield their analytical magic at month-end, declaring success or failure against budgets, while the Revenue Cycle, if engaged, grapples with specific encounter-level questions without full understanding of financial model mechanics. The result? A disjointed process that hinders a holistic and common understanding of performance. In this blog [...]

Navigating Net Revenue and Revenue Cycle Performance: Strategies for Alignment2023-12-21T12:24:26-05:00

Successfully Managing Your Remote Revenue Cycle Team

2023-10-11T20:49:49-04:00

The field of revenue cycle management in healthcare has been rapidly changing over the years leading to an increasing number of revenue cycle teams adopting alternative work arrangements. This trend was accelerated by the pandemic, which forced revenue cycle staff to transition to working remotely. While remote work offers advantages such as flexible schedule and potential money savings, it also presents challenges when it comes to managing a remote team. In this [...]

Successfully Managing Your Remote Revenue Cycle Team2023-10-11T20:49:49-04:00
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