Leading the Business of Healthcare
RCM Advisor

Quarter 3 2019 - Volume 24, ISSUE 3

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Navigating the Evolving Topic of Business Intelligence

Message from the President

By Mick Polo, CHBME, HBMA President

As I began in the medical billing field, some of the highest “business intelligence” needed was simply convincing healthcare providers they should change from their antiquated internal system of pegboard accounting and ledger cards to using a billing company that could computerize and organize all their accounts. A no-brainer!


News from Around HBMA

By RCM Advisor Editors

Are You Maximizing Your HBMA Membership?; New HBMA Members; CHBME CEU Questions

The New Offshore Model

Integrating automation with offshore processes creates a complex, though better model.

By Eliot Payson

Sourcing of claims processing activities to offshore resources by RCM companies has been a standard practice since its introduction 10 to 15 years ago. For ALN, as is the case with most RCM companies, the original driver was cost reduction and scale surrounding manual billing activities, primarily achieved by sourcing to lower-cost workers. Today, the use of offshore is a standard ...

Opportunities Are Endless for Billing Services

RCM companies can leverage the industry trends to collect more and prove the value of your organization's partnership.

By Chris Seib

When it comes to patient collections, trends in healthcare payments tell us that providers are struggling. Though patients owe more for services, providers still rely on the same collection methods from decades ago: print and mail statements....

HIPAA for Business Associates

Always make sure a business associate agreement is in place.

By Marcia Brauchler, MPH, FACMPE, CPC, COC, CPHQ

Business associates, such as billing companies, have been off the radar of the Office for Civil Rights since the inception of HIPAA. However, recent enforcement resulted in a small pediatric gastroenterology practice in Illinois being fined $31,000 because of an infraction by their business associate...

Key Questions to Boost Your Bottom Line and Overall Business

Framing the key questions around your business pillars will ensure you don't miss evaluating the main areas in your business.

By Jasmine Vializ

Being a small business has its perks: you’re fast and agile. The downside is that, as a small business, you may not have the time, effort, and budget available to put into a two-week-long leadership retreat to evaluate your business and make plans to improve...

Creating Healthcare Innovation With Data

Analytics has become the primary path to improve financial, operational, and clinical outcomes.

By Charles Holive

Healthcare is just like any other industry: If you stop building new things, you’ll go out of business very soon. Healthcare data is exploding at an incredible rate, which is a huge opportunity for a new generation of innovators to build (and sell) brilliant new things...

MIPS Big Data

The onus of policing clinicians to stick with actions that bring value to healthcare is on their administrative partners -- like their billing companies.

By Jennifer Searfoss

In 2015, Congress passed the Medicare Access and CHIP Reauthorization Act (MACRA) to reform the Medicare physician payment system, align the quality programs, and replace the sustainable growth rate (SGR). The SGR was intended to cap Medicare program growth. But, for over a decade, the cap had failed and resulted in steep payment cuts to physicians...

Beating Competitors With Analytics

If you can demonstrate better performance quantitatively, you can beat your competitors, get more revenue, increase profits, and maybe even sell your company and retire.

By Sean McSweeney

Analytics is a hot area, and it seems like every conference has presentations on analytics and data, but how many are actually useful? We are focusing on a very practical application of analytics in RCM, which is how it can help you win deals and grow your business...

2019 HBMA Government Relations Committee Annual Advocacy Meeting Summary

SPECIAL Government Relations Update

By HBMA Government Relations Committee

On June 11-12, the HBMA Government Relations (GR) Committee held its annual advocacy visit to the Baltimore/Washington, D.C., region to meet with policymakers from the Department of Health and Human Services (HHS), the Centers for Medicare and Medicaid Services (CMS), the U.S. House of Representatives, and the U.S. Senate.

Patient Relationship Modifiers Are Coming

Coding Corner

By Melody W. Mulaik, MSHS, RCC, CPC, CPC-H

It seems like whenever you turn around, there is another hoop to jump through to get a claim submitted to the payers. The Centers for Medicare and Medicaid Services (CMS) frequently creates new rules that don’t always apply to other payers so they can track specific information and/or ensure they pay things correctly according to their policies...

Arrays Part V

Software Talk

By Nate Moore, CPA, MBA, FACMPE

This article builds on the complexity of our discussion of arrays. Please review the first four articles in RCM Advisor to refresh your memory on arrays. This article will show another example of using arrays to calculate a common medical practice request and introduce arrays that span multiple cells.

Data Is Not Enough -- Clients Need Information

From the Road

By Dave Jakielo, CHBME

There are still some dinosaurs in this wonderful world of medical billing—myself included. My career has spanned over five decades, before it was even called revenue cycle management...

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