Digital health apps have surged in popularity, offering everything from fitness tracking to chronic disease management. For employers grappling with rising healthcare costs, these tools promise a solution: healthier employees, fewer claims, and better productivity.
Don, a 55-year-old union worker from the Midwest, had long struggled with poor sleep and constant fatigue. Diagnosed with obstructive sleep apnea (OSA), he faced difficulties navigating the path to proper treatment and care.
The COVID-19 pandemic significantly changed how people engage with healthcare, leading to the rise of virtual visits, delayed care, and a greater emphasis on mental health. Now, five years later, it’s essential to understand how healthcare utilization has evolved and what it means for employers.
Clinical Documentation Improvement (CDI) is a strategic initiative to enhance the accuracy and completeness of clinical documentation in patient records. By improving documentation, CDI supports better quality of care and appropriate reimbursement. It also enhances compliance with regulatory standards.
Medical billing isn’t glamorous, but healthcare providers don’t get paid without it, and patient care will suffer. Yet billing errors are everywhere, slowing payments and adding unnecessary stress. The good news? You don’t have to live with them.
Population health focuses on improving healthcare outcomes for groups of people rather than concentrating on individual care. This approach considers the broader health factors affecting communities, including preventive care, chronic disease management, and the social determinants of health.
Understanding what constitutes fraudulent billing prevents healthcare providers from undermining their revenue integrity and exposing their organizations to compliance violations. The greatest financial threat to healthcare providers is medical billing fraud.
Patient access is the foundation for efficient healthcare revenue cycle management (RCM), directly impacting the entire billing and claims process. At its core, eligibility verification affects a hospital’s bottom line.
Managing Accounts Receivable (A/R) in healthcare is a complex and ongoing challenge. The nature of payer systems means delays, denials, and inefficiencies that impact patient care.
According to the American Hospital Association (AHA), 78% of healthcare organizations report worsening experiences with commercial payers. Additionally, 84% noted rising costs of complying with insurer policies, and 95% said staff were spending more time on prior authorization processes. That’s why it is important to understand the root cause of these denials to not only quickly resolve them, but also avoid them altogether.
As healthcare costs continue to rise, employers and benefits managers are increasingly prioritizing strategies to reduce employee inpatient readmissions. Beyond the financial burden, readmissions disrupt productivity, impact workforce morale, and highlight potential gaps in care coordination.
Internally managing revenue cycle management (RCM) presents significant challenges for healthcare providers. Having staff available to navigate the complex world of insurance billing and coding while also having people on hand who will keep up with regulations and compliance isn’t enough.
The importance of accurate medical coding cannot be overstated. Aside from getting proper reimbursement for services, the impact on compliance, data integrity and clinical quality indicators, reinforces that coding in the healthcare ecosystem is non-negotiable.
When employees are healthy, everyone wins. Healthier employees mean fewer sick days, better focus, and lower healthcare costs. But keeping a workforce healthy doesn’t just happen by chance—it requires a proactive, thoughtful approach.
There are always unknowns about what the year ahead holds for healthcare providers, especially in years when there is a change in presidential leadership and a new administration.
Billing is the lifeline of physician practices, and every dollar lost to inefficiency or error is a dollar that could support patient care. Gaps in billing processes, frequent denials, and staff shortages can derail financial stability, making it harder to keep operations running smoothly.
There are two aspects of the healthcare industry that perpetually challenge providers: the complexity of the healthcare landscape and the dynamic nature of payers.
Let’s explore providers’ hesitation with automation and why partnering with Conifer Health Solutions can help overcome those fears and challenges.
An optimal revenue cycle and a positive patient experience are intrinsically tied to a provider’s ability to deliver a seamless clinical and administrative experience.
Explore insights on modernizing and optimizing revenue cycle management in healthcare. See how to improve each stage in the cycle.
Provider organizations must address denials head-on. This means aggressively shoring up the appeals process to make it as efficient and effective as possible.
Medication errors cause at least one death every day in the U.S., according to World Health Organization data. More than 40 percent of medication errors are believed to result from inadequate reconciliation in handoffs during admission, transfer and discharge of patients.
Based in the Southeast, a union worker and his wife Alice were experiencing the joys of marriage and dreams of having children. However, expanding their family proved to be a difficult and challenging journey.
Carol is a 48-year-old spouse of a union worker. Based in the Southeast, she originally injured her shoulder while on a beach vacation. She was unable to work, raise her left arm, and experienced severe pain and numbness.
Steve is a 56-year-old male truck driver with diabetes. Based in Florida, this union worker keeps busy on the road with a challenging schedule.
Attention to detail is key in accurate healthcare billing. One of the frequent challenges coders face is handling claim denials, with the CO 6 denial code being a common issue.
Download the complete Navigating the Heart of Healthcare Revenue: A […]
Download the complete Navigating the Heart of Healthcare Revenue: A […]
Download the complete Navigating the Heart of Healthcare Revenue: A […]
Download the complete Navigating the Heart of Healthcare Revenue: A […]
Download the complete Navigating the Heart of Healthcare Revenue: A […]
Download the complete Navigating the Heart of Healthcare Revenue: A […]
Download the complete Navigating the Heart of Healthcare Revenue: A […]
Download the complete Navigating the Heart of Healthcare Revenue: A […]
Discover the state of telehealth and why it is a viable option for providing convenient, high-quality care to those in need.
Patient registration is an often undervalued, yet significant opportunity to enhance the patient experience.
CDI is no longer just a process of adding notes to the electronic health record; it has become a more strategic initiative with far-reaching implications.
Physicians can help CDI teams by providing a level of clinical acumen that CDI specialists may not possess.
Denials due to coding quality concerns are a common challenge in medical billing, often disrupting provider revenue cycles and patient experiences.
The rising cost of providing healthcare coverage for employees has led many organizations to look for alternative solutions for promoting health and well-being.
Research shows that keeping members actively engaged with their healthcare benefits can help improve decision-making, prevent illness, and more.
With sluggish margins and continuing labor shortages, provider organizations cannot afford a status-quo approach to denials.
To reduce medical costs, health plans have begun offering care management programs explicitly aimed at high-risk members and those with chronic conditions.
Just as hospitals, health systems, and physician practices are dealing with unprecedented financial and operational challenges, denied claims continue to rise—especially medical necessity denials.
Download the complete Precision in Practice: Mastering Front-End Revenue Cycle […]
Download the complete Precision in Practice: Mastering Front-End Revenue Cycle […]
Download the complete Precision in Practice: Mastering Front-End Revenue Cycle […]
Download the complete Precision in Practice: Mastering Front-End Revenue Cycle […]
Forward-thinking organizations can reduce episodic care by implementing programs that approach member healthcare holistically.
Download the complete Precision in Practice: Mastering Front-End Revenue Cycle […]
Clinical documentation plays a vital role in creating a complete picture of an individual’s health that clinicians need to develop effective care plans.
The challenge for employer benefit teams is how to implement programs that help employees become more health literate.
Greater financial responsibility leads many to delay or skip care altogether, which can ultimately lead to poorer outcomes and higher costs.
This article will explore the impact of training and development on building an optimally performing patient access team.
This blog explores five key components of an effective patient access strategy that focuses on improving access to care and the patient experience.
Outsourcing all or a portion of the revenue cycle allows providers to achieve optimal revenue efficiencies with lower costs and less overhead.
For hospitals, health systems and physician practices, delivering excellence in care and providing the best outcomes for patients drive what you do. However, there is a financial side to healthcare, and it’s highly complex.
Conifer Health polled provider organizations to discover their concerns and answer their top coding questions.
Compliance management in the mid-cycle can help improve financial viability for hospitals and health systems.
In these challenging times, hospital revenue cycle leaders must do all they can to ensure timely, accurate high-risk charge capture.
When individuals engage with their caregivers on a personal level, they build a foundation for holistic care management and better outcomes.
There is now a way to automate denial management on the back end so denials can be processed without human intervention.
Discover the mid-cycle compliance challenges for hospital systems and proven strategies to help ease the burden of compliance and avoid unnecessary revenue loss.
This blog post covers the four areas hospitals should be focused on to achieve mid-cycle best practices and protect their bottom line.
If there ever was a time to shore up revenue cycle processes, that time is now—especially processes that lead to denied claims.
Discover three interventions providers can implement now to help protect themselves from lagging reimbursements.
Telehealth regulations are shifting, and providers need a strategy to navigate the changes. Learn about what’s changing and what’s staying the same.
Hospitals need sophisticated technologies to better understand payer behaviors that impact the revenue cycle. Predictive analytics and AI is a great place to begin.
Quality coding is essential for a healthy revenue stream. Superior coding can reduce denials, improve cash flow, facilitate faster and more accurate reimbursement, and more.
Specialty coding has become increasingly challenging and nuanced. Discover what these challenges are and how to know when it’s time to outsource.
Many factors can impact the health of a hospital’s bottom line, and coding quality is one of them. Discover how to fix the common coding challenges for hospitals.
Healthcare expenses continue to rise for employers. Learn how the best care management programs offer employees tools to better navigate and utilize available resources.
More than 40% of denials are caused by coding issues. Here are five of the most significant coding challenges across physician practices.
The quality of a hospital’s revenue cycle processes directly impacts the health of its bottom line. Learn four opportunities to Improve Mid-Cycle Revenue Operations
Revenue cycle leadership is changing. Here are five skills today’s revenue cycle leaders need to drive financial prosperity in a post-pandemic ecosystem.
Health systems and provider organizations are facing enormous challenges. In a recent poll, providers ranked five of their most pressing issues, which were staffing (58%), expenses (20%), revenue (17%), technology (2%), and other (2%).
Conifer Health asked webinar attendees about their biggest revenue cycle concerns. This blog tackles those concerns and provides proven, real-world tactics that can be put in place today to help.
For employers, the total cost of providing health benefits, which was $15,013 in 2022, is expected to increase by 5.4% in 2023. Poorly managed chronic disease is one of the top reasons for the increase.
A 41-year-old woman named Jane had struggled with severe depression for many years. The darkness that engulfed her life was compounded by multiple suicide attempts, each a desperate cry for help.
Linda, a 62-year-old woman, had been dealing with more than just her health. She and her spouse were struggling with type II diabetes and hyperlipidemia.
At 47 years old, Mary had already faced more than her fair share of life’s challenges. Her medical history was extensive: heart disease, high blood pressure, high cholesterol, , a prior stroke, anxiety and low iron.
A 23-year-old female with type 1 diabetes was transitioning from inpatient care to home with required daily wound changes that she was not able to manage herself.
In the bustling world of healthcare, where each decision can significantly impact lives, the story of a 35-year-old pregnant woman highlights the profound difference that meticulous care and prompt action can make.
Emily, the 9-year-old girl daughter of a member, was facing a challenging reality. Diagnosed with PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections), Emily’s life was marked by sudden and severe flares that caused depression, anxiety, and behavioral issues.
John, a 64-year-old man, faced a daunting battle with stage IV prostate cancer that had spread to his bones.
Sarah, a 49-year-old woman, found herself navigating the turbulent aftermath of her past. Diagnosed with depression and PTSD due to domestic violence, Sarah’s life was a daily battle.
A 74-year-old diabetic with lung cancer living alone has severe mobility issues that prevent her from leaving the second floor of her home.
Scott, a 60-year-old man living with his spouse, faced a complex medical situation. He struggled with diabetes, cirrhosis, and hypertension, and his high prescription costs compounded his difficulties.
With solutions from Conifer Health and Waystar, hospitals can improve efficiencies, optimize revenue, enhance patient care, and stop chasing revenue on the back end.
One of the challenges hospitals face in this new patient-as-payer reality is that revenue cycle was designed around payer reimbursement, not patient payments. In this article, Conifer discusses five solutions to this challenge.
We’ve picked three of the most pressing challenges hospital revenue cycle leaders face and offer proven ways to turn each challenge into an opportunity for improvement.
Conifer Personal Health Nurses (PHNs) are clinicians who reach out to employees to offer support and guidance, and to educate them about symptoms and integration of their employer’s care providers into a highly personalized package, connecting members with primary care, labs, physical therapy, nutritionists, classes, and even same day primary care appointments.
Revenue cycle professionals can reduce costs and improve operations by implementing technology solutions.
Until new legislation becomes law, providers need to do all they can to automate prior authorizations, standardize processes, maintain highly qualified staff and improve patient communications.
Even with the increased focus on automation, too many revenue cycle operational processes remain highly manual and resource-intensive. This is especially true for mid-cycle processes.
In this article, Conifer shares six guidelines to help physician practices achieve operational excellence in difficult times.
The effects of the COVID-19 pandemic will likely continue to impact healthcare systems for years to come. Implementing digital strategies will help relieve the burden on administration, physicians, and nurses, allowing them to focus on what they do best: patient care.
Hospitals need to do all they can now to make it easier for patients to access and pay for the services they need. If we wait for full compliance, it will never happen and hospital revenue cycles will continue to suffer.
The pandemic has highlighted the need for a more patient-centric, holistic mental health system that is more easily accessible for those in need. Now is the time to implement a new, more integrated mental health benefits program.
Providers and payers must adapt to workforce capacity restraints, consumerism, evolving regulations, increased risk and vigilant financial management to solve new and complex problems.
Strategic outsourcing ensures more confident, better trained staff, speedier turnaround times and maximized returns. Outsourcing key stages of the revenue cycle process, especially those that are patient facing, can increase productivity and maintain positive patient relationships.
Outsourcing revenue cycle management can help mitigate the impact and bring greater productivity, lower costs, and improved outcomes.
Outsourcing scheduling, eligibility and enrollment, and prior authorization processes can help improve the patient experience.
To proactively address rising healthcare cost, employers must focus on those with difficult to manage conditions. This blog outlines three ways to mitigate the cost crisis in healthcare.
Eligibility and Enrollment services optimization is more critical since the great resignation to prevent newly uninsured patients from increasing bad debt costs.
Four key areas where hospital revenue cycle leaders can address these issues with a more strategic approach.
Leveraging health data, employers and health benefits providers can leverage special care management programs to improve employees’ overall health.
Automating the prior authorizations can help reduce denied claims, decrease errors and streamline the process.
This article examines how organizations that adopt a three-tiered best practice approach to coding can improve reimbursement while maintaining coding quality and compliance.
This blog examines the value of improving efficiencies through automation and expanding the labor pool by leveraging best-cost geographies
By simplifying pre-registration and arrival tasks for scheduled appointments, staff members are free to handle non-scheduled events and complete the process in less time.
This blog examines the value of a strategic partner when examining and executing cost-reduction strategies
After implement the No Surprises Act by the January 1, 2022, deadline, providers must now shift attention to refining their processes for what lies ahead.
Dartmouth-Hitchcock Health Achieves 101.6% of Cash Collection Goal
This blog looks at the link of health system transparency to patient trust needed for health systems to meet patient expectations.
Examine strategies for managing healthcare costs through case management, utilization management and utilization review
CMS Direct Contracting Can Improve the Health of Your Patients and Your Practice
This article looks at how healthcare companies can Curate Knowledge in the digital age and how mining data sets can bring new insights.
This article explores why addressing patient concerns is critical to help achieve better health for patients and financial health for your organization.
This article looks at the growing need for hospitals and health systems to focus on authorization services, medical necessity requirements and medical documentation services to maintain financial health.
Two healthcare experts discuss the correlation between liberating liquid healthcare data and the potential it has to revolutionize healthcare and meet consumer demands.
This article examines how focusing on prior authorization is a necessary step in care delivery and is critical to mitigate denials.
This article examines why health systems should look at their routine care model and find innovative ways to deliver the right care, at the right time, in the right place for their patients and community to sustain market relevance.
Strategic partners may be useful to help engage consumers and increase health systems margin pressures for long-term sustainability.
Discover Why Hospitals Focused on Consumerism are Targeting the Mid-Revenue Cycle
Discovery The Transformative Impact of a Technology-Forward Revenue Cycle
Head of Compliance
Head of Human Resources
Head of Information Systems
Technology advancements are enabling health systems to meet consumer’s expectations and deliver a unified patient-centric experience while elevating patient access team members.
Without a well-established clinical documentation improvement program in place, healthcare organizations’ risk rankings falling short of achieving clinical documentation integrity which underscores how critical accurately delivered and documented care reflects the well-being of individual patients and an organization’s financial health. Here are three reasons why implementing a CDI program can prove beneficial to your healthcare organization.
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