For health care organizations, getting paid for what they did used to be a complicated process, but not necessarily complex. But that has changed in recent years. The issues are now complex.

To borrow from the theories of complexity leadership, complicated systems may have many parts, but when the parts interact, they do not change each other.…

In today’s specialty provider market, most organizations are struggling with how to decrease expenses and increase the financial resources available for program development and service delivery. Improving the collection rate for rendered services is a frequently overlooked method to achieve this. Revenue cycle management (RCM), as it’s referred to, is becoming even more critical as…

If a health care practice collects just 80% of all medical claims, that means 20% is left on the table. With target net revenue collection rates of over 95% or higher (see Best Practices For Assessing The Effectiveness Of Your Revenue Cycle Operations and Finances And Your Practice), even with best practice revenue cycle management…

Obtaining prior authorizations for care can be confusing, time-consuming, and frustrating, especially if you work with numerous insurance companies. Each payer can have its own policies governing prior authorizations, concurrent reviews, retrospective reviews, and appeals. Failure to obtain timely prior authorization and continued stay review can result in delayed or denied claims. Specialty provider organizations…

Value-based care (VBC) is a promising funding framework that places quality at the center of health care contracting. It relies on the hope that medical-behavioral health integration will be more effective and less costly than routine care. One potential concern is that VBC has no behavioral health funding criteria, so the adequacy of resources can…