Biosimilars: An Overview for Supply Chains with Pharmacy Oversight

Date: March 15, 2018
Category: Supply Chain

The pharmaceutical market is made up predominantly of small-molecule drugs manufactured through synthetic chemical processes. But biological products represent the fastest growing class of therapeutic products in the United States. Still, biological products are more expensive for companies to research, develop, and bring to market. They often require special handling and processing as they move […]

Pulse Check: Don’t Ignore Capitated Claims

During the last week I audited over 160 accounts for organizations we work with and I have seen an avoidable, yet common, source of delays on accounts. Accounts denied by the primary payer because they have an agreement with a capitated payer are sitting unworked. Though the primary payer states they are forwarding your claim […]

Addressing Concerns Regarding Payer Noncoverage of Inappropriate Emergency Room Use (Updated to reflect 2018 changes)

Update 2018: Anthem has made exceptions to its controversial policy that denies payment for emergency department visits for nonemergent conditions in some states. The payer will reimburse providers in the following scenarios both in the future and retroactively by overturning denials: The patient was directed to the ED by a provider (including an ambulance provider) […]

Reimbursement & Regulations: Medicare Appeal Settlements, TPE, Anthem’s ED Policy

Welcome back to the Reimbursement & Regulations blog series. This month I’ll be highlighting another attempt by CMS to decrease their huge amount of backlogged appeals, a new program by CMS with the goal of decreasing Medicare denials, and an update to Anthem’s emergency department reimbursement policy in certain states. As part of the CMS’s […]

Are You Developing Tomorrow’s Leaders?

When a new team member is hired, their training needs are clear. They need to understand the tools, processes, and policies that apply to their role. Many healthcare providers have formal coursework for new hires, and a holistic revenue cycle curriculum can be invaluable. But when onboarding is done, staff are often left to on-the-job […]

Pulse Check: Subpar PFS System Notes Waste Time and Energy

In Patient Financial Services, staff spend time looking at claims, EOBs, and correspondence letters when working open-balance accounts. But often the most valuable information on an outstanding account is contained within the note section of the patient accounting system. The note section is where staff communicate crucial information to help bring the account balance to […]

The Links Between Informatics and Engagement

Date: March 6, 2018

While many organizations have begun implementing analytics tools to gain insight from enterprise data, those tools often present their own challenges. For example, leaders are finding that those insights alone, without sufficient awareness or activity on the part of physicians, do not effectively impact care processes and outcomes. To that end, developing an understanding between […]

Current Industry Trends and New Regulatory Updates Explored in Cost & Quality Thesis

With a healthcare landscape that is ever-changing, hospitals and health systems need to keep an eye on the latest regulatory updates and emerging industry trends. Geared towards all organizations looking to remain informed on these areas, HBI’s Cost & Quality Academy recently released its annual thesis for 2018, which covers prominent healthcare trends and regulatory […]

Pulse Check: Departmental Process Adherence QA Only Tells Part of the Story

While many healthcare organizations employ QA analysts that routinely check for accuracy, compliance, and departmental process adherence on an employee level, most organizations do not also conduct account-specific QA that follows a claim through the revenue cycle, highlighting opportunities for improvement and training within each revenue cycle area. Situations like this often lead to instances […]