By Mike Perisi, Sajid Khan, and Adam Sullivan The ability for payers and providers to effectively exchange relevant and timely information is a key component in reliable and cost-effective healthcare delivery. Currently, this is a largely paper-driven process with the two parties using tools like fax machines, manual portal uploads, or even snail mail to send clinical documents back and forth. In recent years, payers and providers have had the opportunity to start electronically exchanging these documents in the form of attachments—electronic renditions of medical documentation, such as X-rays ..read more

The healthcare experience is often described as a journey. And while it is one on which the patient travels, an individual is not alone on the path. Providers and payers support and advance patients along their journeys, removing barriers, offering services, and providing clarity. To be effective in this role, payers and providers must follow journeys of their own, which operate in the background but are woven in and around the patient. Taken together, these interconnected pathways not only enable a positive patient experience, but also reduce overall care and operational costs, increase proce ..read more

Understanding the patient journey means setting aside the preconceived notion that the patient is traveling along a healthcare path alone. A successful patient journey also involves payers and providers that are pursuing their own clinical and financial journeys, which interact and interweave with the patient’s. In the previous two articles on this topic (1, 2), we have focused on the pre-visit and visit stages of the patient journey. This article examines the post-visit period and the priorities present for each stakeholder. Preserving loyalty is essential Depending on where you sit in the he ..read more

By Elaine Dunn and Vindali Vartak  If you ask 10 revenue cycle leaders what the primary focus of revenue integrity efforts should be, you might get 10 different answers. Some will bring up denials prevention, while others will zero in on denials resolution. Still others will point to proper documentation and others will focus on charge capture. To a certain extent, all these leaders are right, and a little bit wrong—none of them are describing the full picture. Revenue integrity is not confined to one part of the revenue cycle, and it is not a stand-alone function. In the truest sense, revenue ..read more

Every patient embarks on a journey when they receive healthcare. However, they are not on this journey alone. The experience is shaped, informed, and driven by multiple other journeys that providers and payers pursue alongside the patient. All these pathways are interrelated and can positively or negatively impact one another depending on how consistent and reliable they are. Having an infrastructure in place that can optimize each of the journeys and smooth out points of friction between them is critical to transform healthcare as an industry and make it more cost-effective, efficient, and va ..read more

By Elaine Dunn and Vindali Vartak There’s a lot of talk about healthcare organizations needing to improve revenue integrity to ensure compliance and realize strong financial performance amid changing payment models. But what is revenue integrity exactly, and how can organizations go about enhancing it? Fundamentally, revenue integrity involves making sure that everything that happens from a revenue standpoint during the space of a clinical encounter is accurately captured and translated into a claim. There is a common misperception that revenue integrity is a combination of discreet revenue c ..read more

The healthcare experience is often described as a journey. And while it is one on which the patient travels, an individual is not alone on the path. Providers and payers support and advance patients along their journeys, removing barriers, offering services, and providing clarity. To be effective in this role, payers and providers must follow journeys of their own, which operate in the background but are woven in and around the patient. Taken together, these interconnected pathways not only enable a positive patient experience, but also reduce overall care and operational costs, increase proce ..read more

Healthcare organizations have been trying to effectively capture reimbursement since they began submitting claims for payment. What reimbursement looks like and where it comes from has changed over the years, but the drivers behind the work have stayed the same. Organizations want to receive the appropriate payment for services so they can cover their expenses and have enough money to meet their primary mission of providing top-notch patient care. It takes substantial resources to deliver reliable, high-quality care based on the latest best practice, and organizations need funds to maintain a ..read more

With the rise of healthcare consumerism, people are looking to hospitals, health systems, and physician practices to deliver the same user-friendly, digital experiences they receive from other industries. More specifically, people want to easily make appointments, understand what their financial outlays will be, make payments, and set up payment plans if the estimated costs exceed their budgets—all via their mobile devices or tablets. Unfortunately, most healthcare organizations aren’t ready to provide this level of convenience. In part, this is because they have relied on patient portals as t ..read more

http://traffic.libsyn.com/changehealthcare/Pulse_2020-01-D.mp3For the past 10 years, Change Healthcare and the HealthCare Executive Group (HCEG) have commissioned the Industry Pulse Research Report, an annual effort to “take the pulse” of the healthcare industry. The insights gleaned from this year’s research reflect responses from 445 payer and provider leaders, 80% of which are director level or above. To dig into the results, show hosts Rich Levin and Grant Evans met with Ferris Taylor, executive director of the HCEG; market researcher Michael Brousseau, of Insight Dynamo; and David Gallego ..read more