“Finally Friday!” Revenue Cycle Nightmare

FRIDAY February 19, 2016:

“Revenue Cycle Nightmare”


We could say “Resistance is Futile”
but we’re more of a Star Wars crowd…

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This week, Sharon Easterling, Bill Malm and I will discuss the nightmare that we find ourselves in, these days, and we don’t even have to even mention the Presidential race or Kayne West.


Perhaps FFS wasn’t quite this simple of late, but it is a far sight more simple than all the wonderful Government Solutions now being implemented by CMS, and even Private Payors.

We were hoping to go over any new revelations made by HHS Secretary Sylvia Burwell in testimony before the Senate Finance Committee last week, but the hearing was centered more about the Zirka virus, Puerto Rico and Indian Tribe healthcare services than anything else. But there was one thing that she keeps saying that does point to the eventuality of our nightmares becoming reality…

Included in The Secretary’s submitted testimony are the repeated statements about how the department is dedicated to continuing to “improve” the way providers are paid:

“The Department has already committed to moving Medicare fee-for-service payments to 30% in alternative payment models by the end of 2016, and 50% by 2018. We believe that we are on track to meet our goal, and look forward to working with Congress to build on this progress.”

The train is not only on the track, but it’s heading straight for you. All of you.

So, in our show, we will discuss these quandries, about how the Payors have usurped control over your revenue cycle, via these undeniable changes:

  • The complexity of ICD-10 (relatively speaking or not)
  • The ACOs (aka, who gets paid what?)
  • Population Health Initiatives (bundling and other moves away from FFS models)
  • Private Payors’ highly complex and plan-specific rules for reimbursement
    (what I call ACA-DOA claims… “All Claims Are Denied On Arrival”)and finally…
  • The Growth of High-Deductible Health Plans, and collecting payments up front
    (in what could be called, “Mission Impossible: Patient Financial Services”)

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