Insights and discussion impacting revenue cycle management

This monthly newsletter provides thought leadership and practical advice to help our clients anticipate change and adjust processes in time to optimize performance.

Jennifer Swindle, Salud’s Vice President of Quality and Service Excellence, regularly contributes to HFMA’s Revenue Cycle Strategist magazine.

NEW! Using Seventh Characters: What to Consider

Coding for Smoking Cessation Services

Capturing Transitional Care and Chronic Care Management Appropriately

Coding for Diabetes: The increased specificity for diabetes coding required by ICD-10 emphasizes the critical need for accurate physician documentation.

Coding for Colonoscopies Based on Patient Risk

Understanding Medical Necessity: Paper or EHR templates that have sections for all E&M elements may lead to over documentation, a potential compliance risk.

Understanding the Fate of Modifier 59: Using new ‘X’ modifiers allows for better tracking of bundled services.

There’s Gold in the Zero Balance Review

by Jesse Ford, CEO

After claims are closed, most hospitals and health systems, many with six figures’ worth of claims annually, will not review accounts that have been paid or adjusted off. Certainly, they will look at outright denials, especially if there is a pattern. But closed claims mostly have been the Dead Letter Offices of the healthcare system. And yet, there may be gold in them. In fact, it is likely.

Zero balance reviews, as they are known, offer the opportunity to find out how accurately are payers paying their bills. Often providers don’t know this and are surprised by the results. These reviews also find many claims that can be reopened to recoup lost revenue. Even if it is too late to claw back payments, the zero balance review opens up vast opportunities to improve processes to ensure higher future revenue.

Read our Co-authored Series on Revenue Cycle Management in Community/Safety Net Hospitals

Salud Revenue Partners collaborated with senior healthcare leaders on a series of four articles exploring revenue cycle challenges affecting community and safety net providers. The series was published by Becker’s Hospital Review, a major trade journal, and tells how many community providers, including safety net hospitals, haven’t adequately addressed fundamental challenges in the revenue cycle created by health payment reforms, vast changes in the insurance markets and the rise of healthcare consumerism.

Part 1: Are community hospitals ready for the new world of revenue cycle management?

Part 2: ICD-10 still offers myriad challenges: More turn to outsourced services to generate bills, revenue

Part 3: Meeting revenue cycle’s biggest challenge: The rise in patients’ share of the cost burden

Part 4: The revenue cycle outsourcing decision: finding a responsible partner that improves your finances without burning bridges