Healthcarercm

  Every step in the healthcare re venue cycle, from patient scheduling and clinical encounters to medical coding, billing, and reimbursement, generates data. As hospitals and health systems continue to face financial and operational pressures, many are discovering that basic reporting tools are no longer providing the insights needed to make informed decisions. Basic revenue cycle management (RCM) analytics are typically static reports pulled from an electronic health record (EHR) or billing system. They are retrospective and summarize what happened, but they rarely explain why or what should happen next. Typical questions that can be answered include: How many claims were submitted last week? What are the average days in accounts receivable (A/R)? How many encounters were coded? In contrast, advanced analytics can offer predictive power, cross-functional visibility, and real-time decision support. It can transform RCM data from a rearview mirror that reports history into a GPS to ...

  Driven by an aging population and an increase in chronic conditions like diabetic foot and pressure ulcers, along with a growing trend from acute to post-acute care, the  U.S. wound care market is projected to grow from more than $6.5 billion in 2023 to $10 billion by 2030.  Pressure injuries alone  impact approximately 2.5 million people in the U.S. each year,  claiming more than 60,000 lives and adding costs to the system of anywhere from $9.1 billion to $11.6 billion. This rapid market growth has collided with heightened complexity and advances in treatment options and devices to make debridement coding a high-risk area that can significantly impact reimbursement if done incorrectly. This rapid market growth has collided with heightened complexity and advances in treatment options and devices to make debridement coding a high-risk area that can significantly impact reimbursement if done incorrectly. A Debridement Primer Debridement is the removal of foreign...

Denial management has become a costly and operationally challenging aspect of revenue cycle management (RCM). In 2022 alone,  $19.7 billion was spent on overturning denied claims . Compounding the issue, high-cost treatments experience an average denied charge exceeding   $14,000 per claim . Challenges with denials can impact both financial performance and operational efficiency due to increased days in accounts receivable (A/R), slower reimbursement, and higher administrative costs. Key Reasons for Denials Common issues for denials and increases in A/R days include: Eligibility verification errors:  Incorrect insurance details at the time of service. Coding and documentation mistakes:  Inaccurate coding or missing documentation leads to claim rejections. Missed billing opportunities:  Revenue leakage due to inefficiencies in charge capture. Aging A/R:  Delayed claim resolution impacting cash flow. Claim preparation and submission:  Delayed reimburseme...