All Articles Written by Melissa Clark, CCS-P, RT
All Articles Written by Melissa Clark, CCS-P, RT - President and CEO
Welcome to the archived list of all medical billing articles written and posted to the site by our Chief Executive Officer, Melissa Clark, CCS-P, RT.
All articles are listed below and categorized by date, newest to oldest. Click any article link below to read the entire article.
Understanding Bundled Payments: Implications for Revenue Cycle Management
The healthcare industry constantly seeks ways to improve quality, reduce costs, and enhance patient satisfaction. One innovative payment model that addresses these goals is bundled payments. Unlike traditional fee-for-service arrangements, where providers are paid separately for each service, bundled payments consolidate all charges related to a single episode of care into one comprehensive fee. This approach not only simplifies billing but also encourages collaboration among healthcare providers, aiming for better outcomes at lower costs. Understanding the nuances of bundled payments is crucial for effective revenue cycle management, as it impacts billing, reimbursement, and overall financial health of healthcare institutions. This article delves into the concept of bundled payments, exploring its …
Streamline Prior Authorization to Enhance Revenue Cycle Efficiency
The healthcare industry continues to face significant operational challenges, with the prior authorization process standing out as a particularly cumbersome and time-consuming task. Prior authorization, the practice of obtaining approval from a health insurance provider before a medical service, procedure, or medication is delivered, is crucial for ensuring that treatments are covered under the patient’s insurance policy. However, the traditional methods of managing this process have proven to be inefficient, often leading to delays in patient care, administrative burdens, and negative impacts on the overall revenue cycle efficiency of healthcare organizations. The necessity to streamline the prior authorization process cannot be overstated. By enhancing this aspect of healthcare administration, organizations …
Addressing Billing Errors: A Key Component of Revenue Cycle Integrity
In the complex ecosystem of healthcare, revenue cycle integrity plays a pivotal role in ensuring the financial health and sustainability of healthcare providers. At the heart of revenue cycle management lies the critical task of minimizing billing errors—a challenge that, if not addressed, can lead to significant financial losses and undermine trust between patients and healthcare institutions. Addressing billing errors is not just about correcting mistakes; it’s about establishing a seamless, transparent, and patient-centric billing process that supports the overall goal of providing high-quality care. The consequences of billing inaccuracies extend beyond financial implications, affecting patient satisfaction, compliance with regulations, and the operational efficiency of healthcare providers. Thus, it becomes …
Navigating Pre-authorization and Prior Authorization in Medical Billing
Navigating the intricacies of pre-authorization and prior authorization in medical billing can be a daunting task for both healthcare providers and patients. This comprehensive guide aims to demystify these processes, shedding light on their importance, differences, and the steps involved, as well as providing tips for seamless navigation. Understanding Pre-authorization and Prior Authorization Pre-authorization and prior authorization are terms often used interchangeably in the context of healthcare billing, yet they bear subtle distinctions. Both processes involve obtaining approval from a health insurance company before a patient receives specific services, treatments, or medications. This approval is crucial to ensure the proposed healthcare service is covered under the patient’s insurance plan and …
Week 2 of the Change Healthcare Cyber Attack
The cyber attack on Change Healthcare, reported to have begun on February 21, 2024, has been attributed to the Blackcat ransomware gang, also known as ALPHV. This incident has caused significant disruptions across the healthcare sector, affecting pharmacies and healthcare providers throughout the United States. The cybercriminal group is known for its “double extortion” tactic, where they encrypt the victim’s files and also steal sensitive data, demanding a ransom for both the decryption key and the non-release of the stolen data. In this case, there’s a possibility of a data breach, although it hasn’t been officially confirmed by Change Healthcare at this stage. Mandiant, Alphabet’s cybersecurity unit, is spearheading the …
5 Most Important Aspects of Medical Billing: Melissa’s Mention
Here is an excerpt from an interesting article that has been mentioned by Melissa: “Medical billing is a process where you pay your provider for their services. When we say you, we mean that this is the process where your insurance carrier and you pay the service provider or hospital you were in for deductible charges. Now when you know this let’s put ourselves in the position of a medical institution, clinic, or practice that has to bill for their work. Believe it or not, sometimes it is very hard to do this and these businesses have their work cut out for them when it comes to charging their …
Data can unlock capacity in the O.R. & drive better decision-making: Melissa’s Mention
“Optimizing operating room performance is a tough nut to crack for hospitals because true OR capacity is often uncaptured and underutilized due to rigid scheduling protocols. During a workshop sponsored by LeanTaaS at the Becker’s Hospital Review 9th Annual CEO + CFO Roundtable in November, Sanjeev Agrawal, president and COO of LeanTaaS, and Matt Ruby, director of business operations, surgical services at Northwestern Memorial Hospital in Chicago, discussed challenges and available solutions related to efficient OR utilization. Four key takeaways: 1. Unused OR capacity leads to unrealized return on investment. The OR represents the economic backbone of hospitals but is often underutilized because of the rigidity of block scheduling and …
HIPAA and Professional Sports Figures: Let’s Get the Record Straight: Melissa’s Mention
Matt Fisher clears up some confusion related to HIPAA and individuals on Health IT Answers. “The spotlight continues to shine brightly on HIPAA, especially as an excuse, when it comes to professional athletes responding to questions around COVID vaccine status. The most recent string of erroneous responses started strongly over the summer when NFL training camps kicked into gear. As players returned and the league indicated its intentions for health safety, questions were often posed to players to find where they all stood. Before diving into a bit from my perspective, I encourage readers to check out a similar article by Charles Curtis on ForTheWin with USA Today where I …
Tips for Recouping Lost Revenue From COVID-19 Pandemic
Craig Adkins of AdvancedMD gives HealthIT Answers some tips of how to recoup some of the revenue lost during the pandemic in this article mention. “The past few months of the pandemic have brought many challenges to physician practices, especially small, independent providers operating outside the domains of COVID-19 treatment. While mandatory shutdowns and quarantines have slowed the spread of the virus, the economic impact has been substantial. Fewer outpatient visits—and even fewer procedures—over the past several months have led to serious financial hardship for many providers. Practices that will stay afloat during this challenging time are doing so strategically. In some cases, practices planned for a “rainy day” and …
EHR Training and Experience Lead to Decreased EHR Use by Residents
Are you satisfied with your EHR? Do you spend 40% of your day in your EHR? Research shows that some physicians do.. “Physicians at large community hospitals spend nearly four hours during work hours, or roughly 40 percent of their day, on the EHR, according to a study published in the Public Library of Science (PLOS ONE). Additionally, researchers found a significant decrease in resident EHR use with increased training and experience, although the overall amount of time spent on the EHR remained high. “Studies exploring EHR use emphasized extensive time as one of the significant drawbacks to EHR,” wrote the study authors. “It has been reported that physicians …
