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Eligibility determination and the future of patient payments
Healthcare Finance News
Determining insurance eligibility and estimating patient payment are two of the most overlooked steps in patient engagement and today's revenue cycle process. Yet, they're also arguably two of the simplest steps a provider can take to maximize revenue and profitability. Despite the potential risks, less than 25 percent of physician practices have systems and processes in place to ensure eligibility and estimate what the patient owes at the time of service. With the continued rise of high-deductible health plans and transparency, it's only a matter of time before all providers are dependent on patient eligibility and estimation services.
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How to do software modernization right
Healthcare IT News
The long and short of it is this: Old code deteriorates over time. It begs to be transported to new platforms. With that, though, comes challenges. For payers, probably the most important part of their computer systems are thousands of coded business rules that determine whether or not a particular claim is payable. With the government now mandating that, when organizations take their systems offline for maintenance, they need to extract business rules and modernize, doing this efficiently and cost-effectively is a big deal.
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Addressing patient needs and increasing satisfaction
Executive Insight
Hospitals have a tough job. Aside from the complex medical procedures and daily life-or-death interactions, they are also battling image issues. By nature, hospitals are not typically associated with positive experiences for patients and their loved ones. Luckily, the tide is turning to focus more on not only top-notch care, but quality patient experiences too. Providing quality medical treatment is not mutually exclusive from providing a positive experience, but actually mutually dependent. When patients are more satisfied, less stressed or depressed, they heal faster.
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Save the date: The 2014 Annual National Institute
This year's event will be held at the Manchester Grand Hyatt in San Diego, California, from Oct. 15-17. Registration information will be available in July.

The ANI is attended by nearly 500 National members and over 75 exhibitors. Each year, the members of AAHAM come together to exchange ideas, renew old friends, make new ones and further their knowledge and education in the field of Patient Account Management.

If you have any questions about the ANI, please feel free to contact the National Office at 703-281-4043, ext. 209, or by email at

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To bend the cost curve, first figure out the costs
Healthcare Payer News
The University of Pittsburgh Medical Center is hoping a cost-analysis system from their Italian transplant hospital will become the future of cost measurement here in the United States. Most hospitals use charges to determine cost information. But Robert DeMichiei, UPMC's CFO, said the industry is moving into a whole new world where more accurate cost data is required by payers, patients and providers alike.
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Looking for similar articles? Search here, keyword(s): Hospital costs.

Upcoming webinar

'Telling Your Story; How to Use Technology to Maximize Community Benefit and Reduce Compliance Exposure'
June 18 at 1:30 - 3 p.m. EDT
This timely webinar will summarize the IRS Section 501 r requirements that were enacted with passage of the Affordable Care Act. This intermediate level webinar will cover financial assistance and billing/collection issues, with a focus on utilizing electronic screening for financial assistance.
Registration deadline: Payment must be received on or before June 11

For online member registration, click here.

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ACOs tackle security challenges
Sharing is typically a good thing, but in the IT world it also introduces the risk of data loss. So it shouldn't be surprising that accountable care organizations — groups founded on the premise that exchanging data among providers will improve patient care — are viewed as potentially vulnerable.

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CMS' 2015 IPPS proposed rule: 10 points to know
Becker's Hospital Review
Many hospitals face further decreased Medicare reimbursements next year, as the Centers for Medicare & Medicaid Services released its proposed rule for the fiscal year 2015 Medicare inpatient prospective payment system. The 1,688-page proposed rule also includes proposed rates for long-term care hospitals.

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CMS resets ICD-10 start date
HealthLeaders Media
After one month of silence, the federal government has announced that it will reset ICD-10 implementation for Oct. 1, 2015, the earliest date allowed by law. The Department of Health and Human Services "expects to release an interim final rule in the near future that will include a new compliance date that would require the use of ICD-10 beginning Oct. 1, 2015."

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Get more out of your EHR: A consultant's perspective
Healthcare Informatics
While the overwhelming majority of healthcare organizations across the country have implemented EHRs, it's the work that is done post implementation that will have a greater impact on how a health system succeeds. Indeed, organizations are faced with increasing pressure to deliver clinical and financial results demonstrating the benefits of their implemented EHRs. As such, using the technology to achieve health and efficiency goals — such as attesting to meaningful use, and then population health and care management — should be a high priority at patient care facilities.
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3 healthcare leader strategies
It's a time of great uncertainty for hospitals and other healthcare providers, with changes from the Affordable Care Act, readmission penalties, and financial shortfalls among senior leaders' chief concerns. Effective leadership is essential during this time of transition. To help healthcare CEOs successfully lead their organizations, FierceHealthcare offers the following proven leadership strategies.
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Expanding coverage will boost ED profits
Healthcare Finance News
Implementation of the Affordable Care Act is likely to lead to increased profitability for hospital emergency departments, concludes a new study published in the May issue of Health Affairs. Researchers found that in 2009 the estimated hospital revenue from emergency department care exceeded the costs for that care by $6.1 billion, representing a profit margin of 7.8 percent. Hospitals make enough profit on the privately insured ($17 billion) to cover underpayment from all the other pay groups, such as Medicare, Medicaid and the uninsured, according to the study.
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Missed last week's issue? See which articles your colleagues read most.

    Healthcare spending surges in first quarter (USA Today)
Where do payers fit into population health management? (EHR Intelligence)
Evaluating pay-for-performance (Becker's Hospital Review)
Social media undervalued in customer service (Healthcare Payer News)
Keeping revenue healthy while transitioning to outcomes-based payments (Healthcare Finance News)

Don't be left behind. Click here to see what else you missed.

Utilize your EHR system to boost practice revenue
Medical Economics
It's difficult for small practices to get a return on investment from their electronic health record systems, even if they receive government Meaningful Use payments, health information technology consultants say. Still, it's possible for practices to achieve ROI if they participate in alternative EHR return on investment delivery models that help them garner value-based reimbursement. The two traditional sources of ROI are increased efficiency and higher charges, based on better documentation. Using an EHR to increase efficiency requires major changes in office processes, and the government has recently increased its scrutiny of certain documentation techniques that help practices justify higher charges.
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Going green with waste saves dough
Healthcare Finance News
Hospitals and health systems generate a huge amount of waste each year – by Practice Greenhealth's estimate, 5.9 million tons of waste per year, or 33 pounds per staffed bed every day. The opportunity for cost reduction through smart resource and waste management may be as high as 40 to 70 percent, representing $4 billion to $7 billion, according to the Sustainability Roadmap for Hospitals, a joint research effort by the American Society for Healthcare Engineering, the Association for the Healthcare Environment and the Association for Healthcare Resource & Materials Management of the American Hospital Association.
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