Leading the Business of Healthcare
RCM Advisor

May - June 2018 - Volume 23, ISSUE 3

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Lifelong Learning

President's Message

By Ginger Ryder, CMPE, CHBME, CPC

The days are finally longer and brighter, and we look ahead to summer and all that matters most to each of us. My younger son graduates from college this May, and I look forward to having him come home before he begins the learning that will occur for the rest of his life. You see, most of us, by a certain age, know that lifelong learning is essential to success.


News from Around the HBMA

By RCM Advisor Editors

Are You Maximizing Your HBMA?Membership?; CHBME Quiz; HBMA 2018 Healthcare Revenue Cycle Conference

Chasing Self-Pay Revenue in Emergency Medicine

Main Feature

By Tyler Williams

During the American College of Emergency Physicians (ACEP) January 2018 Reimbursement and Coding Conference held in Nashville, three emergency physician billing hurdles were discussed. This article explores these obstacles and presents practical strategies to improve self-pay revenue and patient deductible management in emergency medicine.

Prior Authorization Headache: Prognosis and Treatment

Feature Story

By Contributed by the American Medical Association (AMA)

Prior authorization is a challenge that needs to be addressed through a multifaceted approach—including research, advocacy, and education—to reduce burdens on physicians and patients.

Are You Leaving Money on the Table?

Feature Story

By Jeff Lin

Utilizing automation, it is possible for billing services to remain profitable without ensuring a return on their work.

Case Study of a Compliance Breach

Feature Story

By Ginger Ryder, CMPE, CHBME, CPC

HBMA President Ginger Ryder details how her company’s IT firm devised a phishing plan to test employees.

Targeted Probe and Educate: The End of Insanity

Feature Story

By Christine Hall, CPC, CPB, CPMA, CRC, CPC-I

Last year, the Center for Medicare and Medicaid Services replaced the traditional form of selecting targets of complex medical reviews with a new strategy called Targeted Probe and Educate and handed the task of review to Medicare Administrative Contractors.

Blockchain, Data Economics, and Healthcare

Feature Story

By Tony Little

How does blockchain change the current economics of data systems?

Services Revisited

Coding Corner

By Jackie Miller, RHIA, CCS-P, CPC

We last addressed prolonged services in the September/October 2013 issue of this journal, and since that time, there have been some significant changes. In 2013, there were only two CPT® code categories for prolonged service, but, in 2016, a third category was added...

HBMA and Healthcare Compliance Pros Launch Healthcare Business Management Compliance Accreditation for Revenue Cycle Management Companies


By RCM Advisor Editors

HBMA has collaborated with Healthcare Compliance Pros (HCP) to develop the Healthcare Business Management Compliance Accreditation for revenue cycle management (RCM) companies, medical practice management organizations and healthcare software vendors.

Excel Functions Every Excel User Should Know, Pt. 5

Software Talk

By Nate Moore, CPA, MBA, FACMPE

The March/April 2018 issue described SUMIF and SUMIFS, two powerful ways to sum cells that meet given criteria. In this issue, we will cover four functions that operate in very similar ways.

Leadership Begins Within


By Michelle Durner, CHBME

Are you a leader? Henry Givray of Leadership’s Calling® says: “Leadership is not something bestowed upon you or granted to you by virtue of your lofty title or set of responsibilities...

7 Factors of a Successful Medical Billing Company

From the Road

By Dave Jakielo, CHBME

Take these steps in your business to avoid becoming obsolete

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