Here are 10 articles published by Becker's Hospital Review this month that offer insight on revenue cycle management challenges, outsourcing of complex claims, the Medicare appeals backlog and more.
1. How to navigate growing RCM challenges in healthcare
During a Navigant roundtable discussion moderated by Molly Gamble, editor-in-chief of Becker's Hospital Review, at the Becker's 5th Annual CEO + CFO Roundtable in Chicago, two health system executives and a healthcare futurist discussed a few RCM challenges and how they are addressing those issues.
2. Hospitals have 60% overturn rate when appealing RAC claims
Hospitals appealed 45 percent of all Recovery Audit Contractor claim denials in the third quarter of 2016, with 60 percent of those claim denials being overturned in the appeals process, according to the American Hospital Association's third-quarter RACTrac survey.
3. 30% of Americans don't know their deductible, out-of-pocket maximum
American employees are alarmingly uninformed about important details of their insurance plans as well as employer's voluntary benefit programs, according a survey from Sun Life Financial.
4. 6 experts share healthcare RCM predictions for 2017
Hospitals and health systems will face a number of revenue cycle management challenges next year as the healthcare industry continues the shift from fee-for-service to value-based care and an increasing number of patients enroll in high-deductible health plans.
5. Outsourcing of complex claims is a trend set to expand, Black Book survey finds
Anticipating lower reimbursement and shrinking inpatient margins next year, hospitals are exploring ways to capture more revenue. This has led an increasing number of hospitals across the nation to outsource complex claims to third-party vendors, according to a Black Book survey.
6. 10 revenue cycle tips from healthcare experts in 2016
A roundup of revenue cycle tips from industry experts.
7. HHS: Court order on Medicare appeals backlog would require improperly paying claims
HHS asked U.S. District Judge James Boasberg to reconsider an order instructing HHS to clear its backlog of Medicare reimbursement appeals by the end of 2020.
8. AHA: Medicare underpaid hospitals by $41.6B in 2015
Both Medicaid and Medicare underpaid hospitals in 2015, according to an American Hospital Association report.
9. 5 questions with EqualizeRCM Services President Michael Hill
Michael Hill, president of EqualizeRCM Services, spoke with Becker's Hospital Review about some of the biggest challenges in RCM and how his company and his management style have adapted to succeed in the healthcare industry.
10. DOJ recovers $2.5B from healthcare false claims cases: 5 things to know
The Department of Justice obtained more than $4.7 billion in fraud and false claims settlements and judgments in fiscal year 2016 — the third highest annual recovery in False Claims Act history — and more than half of the amount recovered came from the healthcare industry.
More articles on healthcare finance:
How CHS, Tenet, UHS, LifePoint and HCA fared financially in 2016
Iowa hospital files for bankruptcy
CMS finalizes cardiac bundle, expands CJR: 10 things to know