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Category \ Revenue Cycle Management

A good patient outcome is the direct result of a good plan of care. This plan is only beneficial if it is developed around confirmed patient diagnoses. Complete and accurate coding of patient diagnoses is the foundation for care provided … Keep Reading
Increasing your patient count is not the first step toward becoming more profitable. That starts by examining your current billing processes, identifying areas that are inefficient and pinpointing steps that are dragging down reimbursement times. Selene Baldonado, director of revenue … Keep Reading
Medical coding bridges the connection between providers and payers with a universal set of codes for all diagnoses, procedures, services and equipment. Coding directly affects revenue generated for an episode. There are several factors to consider to capture the precise … Keep Reading
When we think of medical coding and billing, most imagine these as two completely unrelated functions. Medical coding is associated with the assignment of codes to medical diagnoses, while billing is more commonly thought of as a revenue cycle management … Keep Reading
The 2021 transition to the no-pay Request for Anticipated Payment (RAP) has not been without obstacles for home health organizations, with unavoidable claims processing errors occurring from the start. While some of the previous claim errors have been resolved, the … Keep Reading
The implementation of the no-pay Request for Anticipated Payment (RAP) did not come without its setbacks, both at the Medicare Administrative Contractor (MAC) and home health organization levels. The Centers for Medicare and Medicaid Services (CMS) is correcting internal system … Keep Reading
Effective January 1, the Centers for Medicare and Medicaid Services (CMS) implemented the Value-Based Insurance Design (VBID) Model for hospice and palliative care patients enrolled in Medicare Advantage plans. The new VBID Model requires hospice organizations to submit claims to … Keep Reading
The implementation of major 2021 billing changes is underway and home health organizations are adapting to new operations to stay compliant and manage revenue. One month into 2021, organizations have already learned some tips on succeeding with no-pay Requests for … Keep Reading
The release of the Medicare Home Health 2021 Final Rule didn’t come without disappointment and frustration, although the changes are much more subtle compared to the implementation of the Patient-Driven Groupings Model (PDGM) a year ago. While the implementation of … Keep Reading
Home health organizations have a new hurdle from the Centers for Medicare and Medicaid Services’ (CMS) 2021 Final Rule: the no-pay RAP, which introduces penalties for untimely Request for Anticipated Payment (RAP) submissions. Organizations have many questions regarding submission requirements, … Keep Reading
There is tremendous potential to grow a home care organization by expanding care services, and with the market expected to grow to $528 billion by 2026, adding specialty programs should be a top priority. Successfully implementing a program will require … Keep Reading
A tsunami of change came when the Prospective Payment System (PPS), the method of reimbursement since 2000, was replaced with the Patient-Driven Groupings Model (PDGM) in January 2020. Thirty-day billing periods replaced 60-day periods, three areas are now reviewed for … Keep Reading


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