Tag: Hayes

Beyond COVID: The C-Suite’s Roadmap To A Healthy Financial Outlook

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By Vasilios Nassiopoulos, vice president of platform strategy and innovation, Hayes.

2020 will undoubtably be a year that the healthcare industry will want to forget. The COVID-19 pandemic not only introduced unprecedented care delivery challenges—at least in modern times—but has also left devastating financial consequences in its wake for today’s providers.

Razor-thin pre-pandemic margins of just 3.5% are now met with the reality that 97% of health systems will lose an average of $2,500 per coronavirus case despite incentives. Further exacerbating the situation is an expected increase in denials as healthcare organizations learn how to interpret new guidance around coding and billing for COVID-19 related care.

While many in the C-suite may be tempted to put their head in the sand and wait for the industry to round the corner into 2021, there is an opportunity to change current dynamics in the last lap of 2020. Amid many lessons learned from the pandemic, healthcare organizations must consider the role of sound revenue integrity practices for future preparedness and sustainability.

Progressive revenue integrity models are designed to integrate systems and processes for the purpose of eliminating revenue cycle complexities arising from issues like COVID-19 that can fast become liabilities for providers. Within these models, healthcare organizations are increasingly finding that strong partnerships between revenue integrity, revenue cycle and billing compliance teams are essential. While these functions have, more frequently than not, operated in siloes, embracing shared monitoring and auditing processes can streamline budgets and improve revenue recoupment and generate long lasting collaboration and communication.

To get ahead of the evolving revenue storm, hospitals and health systems can take four steps to get their billing and compliance house in order:

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Hayes Launches Revenue Optimizer To Help Hospitals and Healthcare Organizations Reverse Revenue Declines, Reduce Claim Denials

Finding new revenue opportunities and avoiding claims denials has taken on greater urgency as hospitals and other healthcare organizations face growing reimbursement shortfalls in the wake of the COVID-19 pandemic.

It is why Hayes, makers of the industry’s leading integrated compliance and revenue integrity platform for the nation’s premier healthcare organizations, has launched Revenue Optimizer to equip healthcare organizations with actionable insights that help eliminate barriers to revenue integrity and manage overall financial performance.

A study commissioned by the American Hospital Association (AHA) found that many U.S. hospitals were struggling with ongoing operational losses well before COVID-19, and the median hospital margin overall was a razor-thin 3.5%.

Even with government support from the CARES Act, these margins were projected to drop to -7% in the second half of 2020 without further federal intervention. The study also concluded that, post-pandemic, at least half of the nation’s hospitals would continue operating with margins in the red without any additional support.

“Adding to existing bottom-line struggles, the Centers for Medicare and Medicaid Services identified $29 billion in improper payments in 2019—a trend that will continue as regulatory scrutiny turns to COVID-19 incentive payments.

Further, the addition of nearly 750 new CPT and ICD-10 codes—on top of COVID-19 changes—has created a compliance nightmare that will only exacerbate a devastating financial impact if healthcare organizations can’t stop the hemorrhaging,” said Hayes CTO Ritesh Ramesh, noting that Hayes identified a 20% increase in denials totaling $2.5 billion related to COVID-19 coding and reimbursement challenges alone in the first half of 2020 among MDaudit Enterprise cohorts.

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