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Hospital Administration

Moving from Volume-Based to Value-Based Reimbursement

September 1, 2014 by Andy Salmen

The shift from a volume based reimbursement format to value based one is taking shape across the country. Healthcare providers are being urged to move from payments based on quantity of services provided to payments based on the values of these services.[read more]

Think Like a Reviewer: Utilization Review

August 31, 2014 by Abby Norman

utilization review

One of the major focuses for utilization review teams is the issue of medical necessity. Because medical necessity is a topic that will often bring about the skepticism of Recovery Audit Contractors, it’s important to assess the issue on an ongoing basis.[read more]

5 Issues Associated with Medical Necessity

August 29, 2014 by Abby Norman

Medical necessity

There are few things more frustrating to a physician than a pile of Medical Necessity edits. Medical Necessity is the term we use in healthcare to describe care what is reasonable and appropriate for a patient based on evidence-based care standards.[read more]

Developing Clinical Pathways

August 27, 2014 by Abby Norman

Clinical pathways

When it comes to patient safety, the best way to be prepared is to develop evidence-based plans and strategies to guide patients through the healthcare system. Clinical pathways are being developed in hospitals nationwide to help physicians move patients through the hospital.[read more]

Caring Relationships

August 27, 2014 by Christine Kapsa, NP, DNP

Care coordination is the process of getting a patient’s various clinicians to talk to each other. Preferably with a rational diagnosis and treatment plan. Coordination minimizes duplicated tests, makes transitions from one care facility to another safer, and results in better outcomes. It’s such a simple notion. In theory.[read more]

Collecting Small Patient Balances: A/R Best Practices

August 25, 2014 by Andy Salmen

2014 has certainly had the medical profession dealing with major changes in every facet of healthcare: just about every aspect of the physician practice has been affected by changes in policy and regulations. The ACA has made the recovery of the patient insurance copay and deductible portion of medical claim even more frustrating.[read more]

The 6-Step Service Line Maintenance Checklist

August 25, 2014 by James Dias

checklist / shutterstock

Routine evaluation and tuning at monthly, semi-annual, and annual checkpoints are key to staying ahead of the competition and, more important, keeping up with patient expectations. Here’s a 6-step service line maintenance checklist to keep your program purring like a well-oiled machine.[read more]

Enterprise Dose Management Is Radiology's Opportunity to Lead

August 24, 2014 by Erica Carnevale

AHRA 2014

In a session at last week’s AHRA annual meeting titled, “An Executive Guide to Implementing a Successful Enterprise Dose Solution,” Chris Tomlinson, MBA, director of radiology at the Children’s Hospital of Philadelphia, urged administrators to not be myopic.[read more]

5 Values You Should Prize in Physician Compensation Models

August 22, 2014 by Abby Norman

physician compensation

As we move toward value-based payment models, we might want to consider what values already exist within our healthcare organizations that will be reflective of this shift – and by supporting them, we can lead the charge to newer payment models.[read more]

5 Things CIOs Should Do in Light of the Recent Patient Records Theft

August 22, 2014 by Morgan Brown

patient security / shutterstock

Community Health Systems, which manages 206 hospitals in 29 states, reported this week that they were victims of Chinese hackers who infiltrated and stole more than 4.5 million patient records. The hackers made out with names, addresses and social security numbers for patients across the network during attacks in April and June.[read more]

CMS Proposed Payment Changes for Outpatient Procedures

August 21, 2014 by Andy Salmen

On July 14, 2014, the CMS released its Proposed Hospital Outpatient Prospective Payment System (OPPS) schedule for out-patient departments, ambulatory surgery centers (ASCs) and the Medicare Physician Fee Schedule (PFS). Here are the key points to know about how the proposed changes will affect physician medical billing.[read more]

Visions of Care

August 20, 2014 by Christine Kapsa, NP, DNP

Americans want doctors who care about them, not just for them. Yes, we do want clinicians to be competent and skilled. But above all, we want doctors who genuinely care about our lives, listen to our concerns and allay our anxieties. So the visions of doctoring offered by two physician writers last week presented a jarring contrast.[read more]