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Healthcare RCM Analytics

Healthcare RCM Analytics

By Sean McSweeney
What makes for success in healthcare RCM? Can we create a repeatable widely accepted framework for analyzing success and comparing in order to benchmark?
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Seems Like Charges Are Missing? It's a Safe Bet They Are.

Healthcare RCM Analytics

Non-Destructive Transformation
What is Destructive Transformation such a big issue? We'll explain how this creates huge problems even while it solves a pressing problem with Excel analysis.
November 24, 2021
AR Recovery - Part 2: the Nitty Gritty
What should you do in AR Recovery, or what should you expect if you are a provider? We'll dive into some details and talk about how to make this work and have that cash register ring.
November 23, 2021
Make Sure You Have "Problems"
Does your billing department or billing company have regular problem solving meetings designed to tackle problems in medical billing? We'll discuss how one of these went recently and what you can do to ensure success in your billing. Spoiler alert: it includes analysis and problem solving.
November 19, 2021
Destruction and Transformation
Are you a destructive analyst? We've all been there. We'll discuss what is destructive transformation and why it occurs so frequently in data science and analysis.
November 18, 2021
eClinicalWorks Reports Review
How good is the reporting for eCW? We'll review some of their reports and discuss what is broken, what works, and what could be improved.
November 17, 2021
Kitchen Toasters and RCM Reporting Systems
What do toasters and medical billing reporting have to do with each other? Listen to find out. I think this highlights a huge problem we have in the revenue cycle management industry.
November 13, 2021
Don't Build Data Warehouse - Do This
In a prior podcast we outlined why not to do a data warehouse. In this one we'll expand on that a little and provide a very specific and detailed solution on what you should do instead. And it will save you money, not cost more.
November 12, 2021
Real Estate, iBuyers, and RCM Data
What do Zillow and billing analytics have in common? We'll talk about why Zillow, who is famous for their algorithm, data, and analytics, and others have a problem in real estate and how to avoid that in medical billing.
November 10, 2021
Successful RCM Analytics Implementations
What challenges come up on implementations of medical billing analytics? Not just overcoming resistance, we'll discuss a key challenge and give you the solution that works every time.
November 8, 2021
Resistance is Futile
OK...Start Trek references do we overcome resistance to using analytics in billing departments in order to improve profitability and customer satisfaction? We discuss some problems we've seen and potential solutions.
November 5, 2021
eCW eClinicalWorks "Analytics" Review
We will review eCW eClinicalWorks "Analytics" module in their cloud based application. We'll tell you exactly what it does and does not do. I thin you'll be surprised. We certainly were.
November 1, 2021
Data Science Trends
What's happening with data science and specifically in healthcare? Where are the data scientists most in demand? We'll give you a little update on this and talk about an opportunity. I'll also share something very personal about a healthcare experience with my daughter in the process.
October 28, 2021
Top Medical Billing KPIs - NOT
What are medical billing KPIs? I think this is often confusing and misunderstood. We'll explore what constitutes medical billing KPIs, and what does not.
October 28, 2021
Knuckle-draggers, Sports Fans, and "Analytics"
I'm going to on a rant, so watch out. I feel strongly about this. It's all editorial BTW with a little "analysis" thrown in for good measure. (Tongue firmly in cheek)
October 26, 2021
Overcoming Resistance
Why do so many projects never get started? Or completed? Or are never used? Or fail? Is it the technology? Is it the specification, scoping, or implementation? Or is it something else entirely? Listen to a recent experience and my thoughts on what's really going on. If you want success...
October 23, 2021
Clearinghouse Update - What's sFTP?
We'll give you an update on how it is going with getting data from a big clearinghouse. Also explain what FTP is and how it can be critical to your analytics program.
October 22, 2021
More Dashboard Best Practices
More suggestions and some real specifics on dashboard design that will make them more utilized and more effective.
October 21, 2021
Smooth Operator - Clearinghouses Update
This is a follow on podcast about the challenges of getting access to your data, just do you can actually do analytics. I'm update you on the journey to go through the clearinghouse to get 835s/ERAs.
October 16, 2021
Top 10 KPI - Cash Receipts
A frequent member of Top 10 KPI lists for medical billing is "cash receipts". But what does this mean? How do you calculate it? How often should you monitor it - daily? We'll cut through the BS, tell you what matters and what to do.
October 14, 2021
I Hate Consultant Speak
Do you ever have people talk to you in a way that seems really profound but actually has absolutely no value? This is the art of consultant speak. Billing managers do it too. Listen to hear an example from am MGMA Benchmarking webinar that is really painful and why it stinks to high...
October 11, 2021
Moving Backwards?
We seem to find ourselves simplifying things and implementing less complex solutions. Why? Shouldn't the world be progressing towards more sophisticated and larger implementations?
October 9, 2021
Ever Heard of Simpson's Paradox?
If you haven't heard of Simpson's Paradox you're probably getting hurt by it. Not knowing makes you look bad. We'll explain what it is, how it impacts on you, and what to do to make sure people see you for how well you are really doing in medical billing.
October 6, 2021
Benchmarking from Associations
Don't you want benchmarking around RCM performance? Where can you get it? Where should or be available? What should it accomplish? And do any of these match up to the expectations?
October 5, 2021
Clearinghouses Won't Save You
The follow-up podcast to the last one about accessing data in order to do data warehousing and analytics in healthcare revenue cycle management. Think clearinghouses are your salvation? Guess again.
October 1, 2021
Getting Data When PMS Isn't Doing It
Where do you go when you can't get the data you want to do revenue cycle analytics? To the source, of course! But where is that? And can you get it?
October 1, 2021
Caribbean Islands and Data
Why talk about a Caribbean island and data? Listen to find out.
September 27, 2021
Lies, Damn Lies, and..."Idiocracy"?
What does a dystopian sci-fi political satire have to do with statistics, intelligence, and revenue cycle management?
September 24, 2021
Baseball, Game Theory, And Surprise Billing
What do baseball and surprise biking laws have in common. It isn't "Moneyball". Listen to learn a little about game theory, surprise billing, and arbitration in out of network medical billing.
September 22, 2021
Coin Flips, Gambling, and Healthcare
What do coin flips and gambling have to do with checking in patients? We'll explain expected value and discuss why it is important in healthcare revenue cycle management.
September 16, 2021
OK, So I'm Not Normal
I think about things differently than the average person. I'm a quant. In economics we used to think everyone behaved rationally, but with the advent of behavioral economics we know that's not true. So how can we change our thinking in healthcare that helps us? We offer a really important suggestion.
September 15, 2021
Reporting Lag Time Secret - Denials
What's the solution to the reporting lag time issue? For denials it's easier than you think. I'm share my incredibly valuable Secret on what you do to avoid having to wait 6 to 9 months to know what is going on.
September 14, 2021
Don't Build a Data Warehouse
Everyone suddenly wants data warehousing. We'll discuss whether this is a good idea (wait...what? Sean you love data warehousing) and for who and when.
September 11, 2021
Surprise Billing Law and UCR
The new federal surprise billing law is complicated and has some interesting aspects to it. Data had always been a key part of determining reimbursement and we explore how this new law changes things with respect to medical billing for emergent and inadvertent out of network claims.
September 10, 2021
Average Denial Rate
What is the average rate of denials on a percentage basis? What is the top quartile? How good can you actually get? What are the key things to implement a successful denials management program?
September 3, 2021
Kill Your Dashboard
A few more best practices about healthcare financial dashboards...including when you should just scrap it.
September 2, 2021
No Appetite for Analytics
Follow up to HBMA podcast about lack of data and analytics at the conference. I discuss why it isn't there with recent revelations about the revenue cycle management industry.
August 31, 2021
Benchmarking Catch-22
How can providers benchmark financial performance without exposing sensitive competitive information? We tackle this problem and offer a solution.
August 25, 2021
Interoperability and 21st Century Cures Act
The solution is nigh...or is it?
August 18, 2021
Are Denials 99% Avoidable?
What kind of target is achievable or even realistic in avoiding medical billing denials? What is "normal" and what is exceptional? And can it be replicated? Listen to find out what we just ran into.
August 16, 2021
Denials Reporting Lag
Denials reporting is among many in healthcare finance and revenue cycle management where we are forced to look at really old data instead of current. Why? Does it really have to be this way? We have a different view than most and offer a potential solution to help. Listen to find out.
August 13, 2021
No Data and Analytics at HBMA Conference?
Looking at the agenda for the upcoming HBMA Conference I was floored to see there is nothing about analytics or data going on there. What is happening?
August 11, 2021
How Long Is Long Enough To Wait?
How long do you need to wait in order to get financial results? Should you have to wait a day? A week? A month? A year? What about other information? What about RCM performance results? Listen to hear our take on reporting.
August 7, 2021
Denial Recovery Rate
What is denial recovery rate, how do you calculate it, and what is it good for? We'll discuss whether this is a good RCM KPI (spoiler: it isn't) and why.
August 4, 2021
Staffing Problems
What is a healthcare provider or a medical billing company to do when you're short staffed and are having a hard time hiring enough employees? The consequences can be dire. Listen to hear what this means for your organization, what your options are, and what you might consider doing.
August 2, 2021
AR Recovery
What is AR recovery and why should everyone be doing it? We'll explain what it is and why it's the best thing since sliced bread.
July 29, 2021
Dashboard Best Practices
What are the Do's and Don't's for creating a healthcare financial dashboard? Best practices and common mistakes are discussed in this podcast.
July 28, 2021
ETL Module - Beta Testers Sought
If you are interested in our denials management application for beta testing, it comes with the ETL module that extracts, cleans up, and joins data from your system(s). Please contact us if you are interested.
July 26, 2021
What's MECE and how can it help your organization when it comes to RCM Analytics?
July 20, 2021
Real Estate Side Hustle - Part 2
Money I save I often put into real estate to diversify and this is the second part of the story about how I used data and analytics to make money in my personal life.
July 19, 2021
Dashboards vs Reports
What's the difference between a dashboard and a set of reports? Most people find them indistinguishable, and yet that destroys the value of dashboards. Listen to our take on this.
July 16, 2021
Denials Management Software - Seeking Beta Testers
We are offering a limited number of organizations free usage of our new denials management software. Listen to find out some of the features of what it does, as well as benefits, and how to apply and see if you qualify.
July 15, 2021
Data is Everywhere, Use It And Make Money
This isn't even about healthcare. It's about a personal story of looking at how I approach things analytically and modifying and improving that approach. And then making a bunch of money.
July 14, 2021
What does HIMSS have in store for us analytics nuts?
July 2, 2021
Denials Management 100
What comes before denials management 101...denials management 100. In order to do basic denials management in any way, whether it is analytics or basic medical billing denials workflow, you need data and we'll discuss some ways to get that if you're having trouble.
June 30, 2021
Denials Management 101
What is the first thing to do in implementing a denials management process? What gives the greatest bang for the buck in time to implement and cost? Listen to find out what should be step 1.
June 28, 2021
Top Practice Management KPI's
Who has good practice management KPI's? While we usually slam organizations for poor, non-existent, or fictitious metrics, we'll share with you an organization that has come up with a good list...and their list.
June 24, 2021
Good vs Bad KPI's
Is everything bad in RCM metrics? Are we just hypercritical? There have to be good medical billing KPI's right? Listen to find out.
June 21, 2021
Charge Recon Labor Savings
How many hours of a high level analytical resource does it take to do charge reconciliation every month? We've gotten a quantification from a client where we deployed our Charge Recon application. Listed to find out.
June 18, 2021
Automating Charge Recon
How much time is saved by automating charge reconciliation? Not doing it or doing it on excel? Charge recon is finding encounters clinical missing from billing.
June 16, 2021
Our Job is Never Done
Why can't it be that we just do a quick analysis and we're done? We explore the operational challenges that make this a pipe dream or dare I say fantasy in RCM analytics.
June 12, 2021
Denials Definition
What constitutes a denial? Does everyone agree on this definition? Why does it matter what we include? Check in to hear our thoughts on medical billing denial definition.
June 10, 2021
Traction Gap
What can we learn from venture backed startups (like Slack) that applies to healthcare providers? Are there any frameworks that could make them more successful and how do these relate to analytics?
June 8, 2021
Charge Recon and Business Rules
What issues can you run into doing charge reconciliation? Errors can undermine your ability to find missing charges. Listen in to find a key tip for success.
June 5, 2021
Idiosyncrasies of Cultures
Wyatt do idiosyncrasies of cultures have to do with medical billing and performance? Listen to find out and hear some tips to improve RCM ave your analytics.
June 3, 2021
Another Rant About Stupid Metrics
You won't believe the dumb things on this massive RCM company's website. It kind of makes you cringe. They should either fire their entire marketing department or operations's not clear which.
June 1, 2021
The Future of Compliance
What do you need to be doing now in order to ensure regulatory compliance? We'll talk about data, analytics, penalties, and audits.
May 27, 2021
What Does Basketball and RCM Have to Do With Each Other?
We'll take you through some fun examples of what to consider in making a good basketball team and what this has to do with medical billing.
May 24, 2021
Patient Balances
Is there an easy way to collect more money from patients? Here is one SECRET we have implemented for clients that significantly improves patient collections.
May 21, 2021
Conditional Logic Solutions
We put some real effort into finding resources for teaching conditional logic. Listen to find out why this is so important in medical billing and where to get some FREE courses.
May 20, 2021
Alice in Puzzleland
What does the great Raymond Smullyan have to do with revenue cycle management analytics? Listen to find out (and learn about my goofy childhood).
May 17, 2021
What is conditional logic?
What the heck is this thing? Why does it matter in medical billing? Is it only for analysis or does it impact anything else?
May 13, 2021
Rules in Heads - Part 3
Why are there so many problems and so much resistance to codifying rules in medical billing so they can be analyzed and measured? Let's look at why and what to do about it.
May 11, 2021
Joshua Tree
May 7, 2021
Medical Billing Rules in Heads - part 2
What happens to those medical billing rules that are in everyone's heads? Your company needs those and there are competing reasons fighting to get those out or keep them secret.
May 5, 2021
Rules in Heads
There are a ton of little nuances to billing that everyone in the industry know exist. What does this do to your analysis?
May 3, 2021
Routing Remittances
Which claim remittances and correspondence go to which departments in the medical billing company or division? It depends. Listen to find out about a huge productivity boosting analytics setup for your department.
May 1, 2021
Analysis or Quality Control - Which is More Important?
Ever find a mistake or a problem in an analysis? Who hasn't. The question is not how to prevent it, but how much time and effort needs to be devoted to finding mistakes in RCM analytics compared to the actual analysis itself. Listen to find out the ratio we suggest.
April 29, 2021
Contact Compliance - Part 2 - Finding Problems
Are you ready to do the quality control to figure out if all those incorrect payment flags are actually incorrect payments or just an error in the system? We'll dive in so you can know what you'll need to do and how to plan for it. In the end you can catch insurance companies underpaying you.
April 26, 2021
Are Payers Underpaying You?
How can you tell if you're getting taken advantage of by insurance companies? Are they underpaying you according to your contract? What are your options for catching this?
April 24, 2021
GIGO Insurance Name
Running into problems where you have lots of different payer names fire the exact same insurance company? Why does this happen? What kind of problems does it create? And how can you fix it?
April 22, 2021
Tiers of Reporting
What do different people in the organization need for data and reporting? What kind of analysis is appropriate for a biller compared to a CFO of a system? And how can that be obtained for all those levels?
April 19, 2021
How to Control Your Data
If you want a medical billing company to bill for you, how do you ensure that you keep your data or control the data so that you are safe in the event something happens? We walk you through the typical decision process and what your options are.
April 16, 2021
Figuring Out What is Needed - Ugh!
Trying to define exactly what software you need built or what you need analyzed can be extraordinarily difficult. Here are some of the issues typically encountered and a suggestion on how to improve outcomes.
April 14, 2021
Missing Encounters - the Why
If this is such a quantifiably large problem, why are so few organizations doing charge reconciliation to find all the missing encounters? Let's walk through the issues so we can set them up to be solved. Then an those claims can be billed.
April 12, 2021
Scope Creep in Analytics
What is scope creep? Why does it occur? What can you do to mitigate it? These are difficult questions when it comes to analysis and software development. We'll talk through some of these issues.
April 9, 2021
Seems Like Charges Are Missing? It's a Safe Bet They Are.
Ever feel like not everything is getting billed but just can't put your finger on the problem? This can be complex, especially because no one may know how to quantify the problem. Listen to hear about charge reconciliation.
April 7, 2021
Multiple Systems for Medical Billing Companies
Billing companies are often forced to use many practice management or EMR systems in order to do billing, but this poses some huge challenges in data, reporting, and analytics.
April 5, 2021
Customized Reports
Why are custom reports needed so often and yet few get them? Big systems are notorious for not charging a ton of money for every module, feature, and report. Listen to hear our thoughts on this.
April 3, 2021
AR Aging Buckets is Antiquated - Possible Solution
If AR aging buckets isn't the best way, what should medical billing teams do to prioritize and work claims most efficiently? Listen to find out.
April 1, 2021
AR Aging Buckets is Antiquated
This is one of the most common tools used in medical billing and yet it has limited use and lots of issues. We'll examining some factors involved and discuss what is better.
March 26, 2021
Out With The Good, In With The Bad
Sometimes we have problems with our data and it's because we made good data into bad data. Listen to find out about what we found in the operational workflow when we were automating charge reconciliation for a medical billing company.
March 24, 2021
Patient Net Collection Rate >100%?
How is it possible that you can have more than a 100% patient net collection rate in medical billing? Listen to find out how this sometimes happens, what it means, and what you need to do to address the problem.
March 22, 2021
Calculating Patient Net Collection Rate
What is patient net collection rate in medical billing? How do you calculate it? What is a good performance level to achieve? What are some tips and nuances in this arena?
March 19, 2021
Vague Answers and Promises - Part 3
Sick of promises that aren't kept? Vague statements that seem to answer the question but don't really commit to anything in medical billing, software, or RCM vendors? Here are some detailed methods to make sure you end up with the result you want.
March 17, 2021
Promises and Vague Answers? - Here Are Solutions
In a prior podcast we talked about healthcare vendors, employees, and software companies that make vague promises or try to make things look great without much substance. Here is the meat on how to dig in and get the answers you want to evaluate how real it is.
March 15, 2021
Sick of Promises and Vague Answers?
Vendor promising something that you want? Trying to figure out if you will get results or just a headache and a hole in your wallet? How can you distinguish fact from fantasy or deception? Software, billing, reporting...this happens everywhere. Listen to hear what to do.
March 12, 2021
Fields You Can't Report
Why are there so many fields you can't report from healthcare revenue cycle management systems (practice management systems, medical billing systems, HIS, RIS, LIS, etc.)? Don't you want this information?
March 10, 2021
Denials, Hard to Collect Claims, and Economies of Scale
Why do economies of scale matter so much in medical billing when it comes to hard to collect claims? Shouldn't it just be that it is a question of hard work, being detailed and thorough, and having good billers?
March 9, 2021
Insiders Tip - Saved Reports
There are not a lot of free lunches out there, but saved reports are one of the most important in healthcare revenue cycle management and medical practice management.
March 5, 2021
Fraud or Incompetence in AR Analysis?
Looking at the spreadsheet calculating net collection, medical billing performance, and accounts receivable balance, we found massive problems. Don't make these mistakes like they did.
March 3, 2021
Bank Reconciliation Part 2 - Action Plan
Missing money? What specifically needs to be done in order to reconcile medical billing collections to deposits in the bank account? Here is the detail.
March 1, 2021
#1 Fake Medical Billing KPI
What's the #1 fake metric or KPI in revenue cycle management / medical billing? Listen in to find out.
February 26, 2021
Simple Compliance Analysis You Can Do
If someone in your organization is billing something incorrectly, whether accidentally or intentionally, you may face huge legal and financial consequences. In this podcast were show one simple way to check compliance using data.
February 25, 2021
Missing Deposits - Not Matching Collections?
Have you ever tried matching bank deposits to a collections report? Bet it didn't line up. Now what? What are the problems that can lead to significant mismatches? We'll talk about why bank reconciliation is so important to stem losses.
February 24, 2021
Denials - A Reporting Problem
Certain issues like understanding how your system stores data is critical. Especially whether data is overwritten or stored as a separate record. There is often a problem that prevents a lot of analysis, i.e. you can't get the answer to your question. What is a "state change" in your medical billing software, what does it mean for you, and how can you deal with it to get your questions answered with data?
February 22, 2021
Medical Billing Charge Reports - More Than Meets The Eye
Isn't it simple - just run a "charge report"? But what if the question you are trying to answer is not the same as your colleague? How many different types of medical billing charge reports are there and what are their purpose? What should be in them and how should you quality control them? This is way more complex than most people realize if you want to do it well.
February 18, 2021
Medicare for All...Again?
Once again Medicare For All has resurfaced since Democrats have taken control of the White House. In this non-partisan discussion we look at whether this is a sound financial policy.
February 16, 2021
Do Insurance Companies Tell the Truth? Part 2 - Some Results
Medical claim denials contain information from insurance companies. Are they telling the truth? Listen in to find out as we analyze the data to find the truth.
February 12, 2021
Reviews of Reporting Capabilities in Billing Systems
Do medical billing systems have good reporting? What do user reviews indicate? We look at the average rating (positive or negative) of reviews that comment specifically about the capability of reports and analytics.
February 11, 2021
Can You Trust Insurance Companies To Tell the Truth?
Can you rely on the information in a medical billing remittance (EOB / ERA) from health insurers that tell you what to do to modify, resubmit, or appeal claims in order to get paid?
February 8, 2021
Average Reimbursement Analysis - Part 2
We dive in more deeply here to look at how this is calculated and what went wrong. Is the medical billing company trying to pull a fast one on its client? Listen in to find out.
February 5, 2021
Average Reimbursement Analysis from Billing Company
Caveat emptor when it comes to getting analysis done for you. Listen here to find out all the problems we see in what should be a simple analysis of average reimbursement from a medical billing company. And we'll tell you what to do.
February 3, 2021
Office Ally Reports
Office Ally is free medical billing software (clearinghouse, practice management system PMS / EMR). We briefly review be reporting capability.
February 2, 2021
Secret Denials Management Tip
Not going to give this one away in the description. You'll have to listen to find out this tip on how to improve your medical billing denials management process using an analytical trick.
January 28, 2021
Correlation and Causation
A fun little episode about the difference between correlation and causation and some spurious correlations for entertainment.
January 28, 2021
Worst Insurance Payors - Part 2
There are other metrics on which you can evaluate whether a payor is bad, other than just denials. We'll take you through a couple and suggest what to do.
January 27, 2021
The Worst Insurance Payers for Denials
Who are the worst payers? How do you identify your "worst" list? And what do you do about it once you have this naughty list?
January 23, 2021
Gross Collections Rate Metric
What is gross collections in medical billing, how do you calculate it, is it valuable, and what are the pros and cons of this metric? We'll break it down for you.
January 21, 2021
How to Know if Your Billing (Company) Is Good
How do you know if your billing or billing company is performing well? Do you just ask them?
January 20, 2021
"Payment Velocity" is a BS Metric
I'll going to go off again on one of my favorite targets Kareo. They have a metric that is called Payment Velocity and it is complete and utter garbage. Listen to find out why.
January 16, 2021
Data in Eligibility Verification Problems
Eligibility verification problems in medical billing can really destroy the financial success of a provider. This is the story of a catastrophe because of eligibility problems, finger pointing, confusing data, very complex problem solving, and ultimate success.
January 14, 2021
How do you calculate denials rate?
What counts as a denial? How can you actually calculate, what fields are you going to use, what unique key will allow you to figure out what counts and what doesn't and are your denials getting better or worse? This is much more complicated than you might think. And it's necessary to improve your medical billing.
January 13, 2021
Billing Company Pricing and Perverse Incentives
What's wrong with flat rate pricing from a medical billing company? Everything. Incentives drive behavior and we'll discuss how this undermines performance.
January 12, 2021
Why Are Hard to Collect Claims Not Worked?
Notice we didn't say collected. Why are they not even worked frequently or at the level they should be to maximize revenue for a provider? We show you the answers and you may be surprised.
January 8, 2021
Happy New Year, making data-driven decisions, and a mea culpa
Where can we be more data driven? How can we make decisions that are better informed? This year we should be making a commitment to improving our business and profitability through data. And that includes Apache.
January 7, 2021
Happy Holidays
We'll be off for a week for the holidays.
December 25, 2020
Measuring RCM Productivity Part 2 - Solutions
We provide you some simple solutions on how to measure the productivity of medical billing team members for various different parts of the revenue cycle including patient registration, charge entry, accounts receivable, collectors, etc. We even offer a few higher level answers to more nuanced and complex issues you encounter.
December 24, 2020
Surprise Medical Bills No More?
Congress looks set to pass a bill that will eliminate surprise medical bills for patients.
December 22, 2020
RCM Productivity Metrics
What should you measure to figure out productivity in medical billing? What do you do to make sure the people don't be in the system or do you want to create incentives that actually result in good outcomes?
December 19, 2020
Medical billing service and medical billing software - one-stop-shop good?
Is the trend towards practice management / medical billing software companies offering outsourced medical billing service a good one? And for who exactly?
December 18, 2020
Are health insurance companies screwing doctors with underpayments?
How do you know if you're getting underpaid and are insurance companies doing it intentionally? Is there a way to know conclusively? (We use "doctors" as a symbol of all providers, whether it is hospitals, laboratories, physicians, ASC's, imaging centers, or other providers.)
December 16, 2020
Medical Billing Blame Game Part 2
When finger pointing happens in medical billing, whether it is with an external billing company or in-house department, what do you do? How do you know who is responsible for claims not getting paid? We have a suggestion.
December 11, 2020
The Blame Game in Medical Billing
What do you do with the inherent problems of the blame game? Who is responsible when claims don't get paid or there is a problem? Billing blames insurance, insurance blames billing. Now what?
December 9, 2020
Dethroning AR Days
Why AR days should NOT be the gold standard in measuring accounts receivable and medical billing performance.
December 9, 2020
Medical Billing Company References
How do you evaluate and select a medical billing company to perform you billing? Reference are the number one method and we'll discuss whether that is a good criterion.
December 7, 2020
Defining Metrics, KPIs, Data, Analytics
Defining and getting through the marketing BS on RCM and medical billing terms and acronyms.
December 4, 2020
RCM visualization tools, "analytics", and...dynamite
What do medical billing, financial data, analytics, and visualization tools have to do with dynamite? Listen in to hear about Xifin Revenue Cycle Management "business intelligence" solution.
December 3, 2020
ASCs, EMRs, and Data Mining
Why do so many ambulatory surgery centers not have EMR? Will it change? We look at a hypothesis on why, what the impact is, as what you can do with data mining until it is implemented.
December 2, 2020
What to Pivot to Find Payer Problems
How do you figure out what payers are unwilling to pay? What CPTs are going to get denied in medical billing? What's the right question and what's the right way to analyze to identify and prevent problems with insurance companies?
December 1, 2020
What's a Good Use of Time in the Pandemic?
What can you do when you're alone in your home office?
November 24, 2020
Bridging the Medical Billing and Technical Teams
How can people who don't understand each other communicate? Billers don't know software, database structures, etc. and IT people / analysts don't know billing. What's an organization to do when you need answers?
November 24, 2020
athenahealth Review
Does athenahealth have a good medical billing system or is it just an EMR/EHR and is their reporting good? What are the major pros and cons?
November 21, 2020
Epic Software
Is Epic Software really epic when it comes to reporting? Find out in this podcast discussing the reporting capabilities of one of the largest hospital and EMR software companies on the planet.
November 19, 2020
Revenue Cycle Management is the wrong name
What are we focused on in our industry? Seems like our target is off the mark in medical billing and we're looking at metrics and KPIs that are not in alignment with our financial goals.
November 17, 2020
Most Important Denials Metric
I'm giving you one of our most secret Secrets for RCM Denials Metrics. The most important KPI there is for your medical billing appeals process.
November 15, 2020
Data is sexy
What does Guy Kawasaki have to do with revenue cycle management? Listen to find out.
November 13, 2020
RCM Analytics Learning Loops
Often when you do revenue cycle management (RCM) analysis, you and up not getting the answer you were going for. And suddenly you need to look at why, are there different questions, and how does this impact on my data?
November 11, 2020
Rushing to Analysis
Let's be honest...Data prep sucks. Wouldn't you rather just do denials analysis? Hear what happens when analysts focus on analysis instead of what is even more important...
November 10, 2020
Top 10 Medical Billing KPI's...That Aren't Actually KPI's At All
Why is it that so many consultants, billing companies, and software platforms in RCM / revenue cycle management / medical billing give you such garbage advice? They after even actual performance metrics, just best practices at best.
October 24, 2020
Analytics and Calling BS
How many times have you heard the buzzword analytics in healthcare and revenue cycle management? Seems like at what conference and in tons of articles we're being bombarded. But is it really analytics being offered?
October 22, 2020
Reason codes extracted - now what?
Now that we extracted reason codes from the text field Notes in the medical billing system (aka EMR), can we figure out the top problems to solve?
October 21, 2020
Extracting denial reason codes
When it's ugly just trying to get the information you want. How do you solve medical billing problems when you can't get good data on what is being rejected ir denied and why?
October 20, 2020
Clearinghouse rejection reports
Diving into denials reporting for medical billing for one of our clients takes me to a clearinghouse rejection report and the result is surprising.
October 18, 2020
The RCM Journey
What's the best way to tackle the entire healthcare reimbursement system problems? I'm going to find out.
October 16, 2020