The Hayes Blog | MDaudit
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Our blog covers a range of strategic, clinical, and financial issues affecting healthcare organizations. Hayes helps healthcare organizations succeed by streamlining operations, improving revenue, and enhancing technology.
The Hayes Blog | MDaudit
1w ago
Following the aftermath of the recent cyber-attack on Change Healthcare, which led to the temporary disconnection of numerous customers from their regular data feeds, a renewed interest has emerged in protecting operations and ensuring contingencies are in place.
Business continuity is everything in the aftermath of a cyber-attack. Presently, many healthcare organizations remain in limbo without access to important services, such as claim processing for prescriptions, and daily workflows around auditing and reporting.
Cybersecurity is something that everyone recognizes ..read more
The Hayes Blog | MDaudit
3w ago
Accuracy and efficiency in billing compliance, revenue integrity, and health information management (HIM)/coding processes have never been more critical. As healthcare professionals navigate the industry’s complexities, more organizations are championing the cause of automating traditionally manual billing audit processes.
At the end of the day, it’s a given that manual processes are no longer best serving the audit process. The mounting amount of payor regulations and scrutiny, combined with complex claim data require a risk-based, and automated approach.
The Need for Automation in Hea ..read more
The Hayes Blog | MDaudit
1M ago
With payor scrutiny at an all-time high and the need to provide excellent patient care, many organizations identify with the challenge of navigating both. While external audits are increasing, the tools for successfully managing them are available! Helping to bring back a healthy balance between patient care and revenue margins is at the forefront of technological innovations.
Industry Statistics
2023 Benchmark Data revealed the following headwinds that healthcare organizations are facing with external audits. Payors are heavily investing in AI and machine learning to drive efficiency and retu ..read more
The Hayes Blog | MDaudit
1M ago
Traditional audit methods, while valuable, are no longer sufficient to navigate the intricate web of payer regulations and the need to optimize financial outcomes.
The Evolution of Healthcare Audits
Historically, audits in healthcare have often been reactive, responding to identified issues or triggered by compliance concerns. The landscape has evolved, and the industry is now recognizing the necessity of a proactive approach to identify and mitigate potential risks before they escalate. Proactive risk-based audits involve a strategic and systematic evaluation of billing processes, focusing on ..read more
The Hayes Blog | MDaudit
1M ago
The transition from fee-for-service to value-based care reflects a broader shift towards a more sustainable, efficient, and patient-centered delivery of care– a transition that MDaudit proudly supports through technology and analytics.
In the pursuit of billing compliantly and maximizing value-based care reimbursement, hierarchical condition category (HCC) coding ranks high on the list. The proposed Medicare Advantage 2024 Advance Notice released by the Centers for Medicare and Medicaid Services (CMS) begins implementation this year. While the CMS-HCC model V28 will be phased in over th ..read more
The Hayes Blog | MDaudit
2M ago
Claim denials stand as a barrier to seamless revenue cycles and patient care. Understanding the intricate web of responsibilities behind claim denials and implementing efficient denial routing strategies is crucial for healthcare billing compliance, coding, and revenue teams.
Defining the Claim Denial Process
Claim denials, often viewed as financial setbacks, are not singularly attributed to one party within a healthcare setting. Instead, they stem from various stages of the revenue cycle, implicating multiple stakeholders in the process-
Frontline Staff: The ini ..read more
The Hayes Blog | MDaudit
2M ago
In the intricate landscape of revenue cycle management (RCM), the pursuit of accuracy, compliance, and efficiency hinges on eliminating inefficiencies.
The Challenge of Inefficiencies in Healthcare Revenue Management
In healthcare, inefficiencies significantly impact bottom lines across the revenue cycle continuum- impacting coding practices, billing compliance, and revenue integrity assessments.
At MDaudit, the commitment to eliminating inefficiencies aligns with the core ethos of fostering equitable and patient-centric healthcare practices. We believe in using storytelling data and an ..read more
The Hayes Blog | MDaudit
3M ago
Changes are coming quickly for Medicare providers who provide services in hospitals and skilled nursing facilities regarding the use of split shared services. The new rules from the Centers for Medicare & Medicaid Services (CMS) come into force on January 1, 2024.
One of the most significant involves billing when patients are seen during a primary E/M visit by both a physician and a nonphysician practitioner (NPP) such as a physician assistant, advanced practice registered nurse, nurse practitioner, clinical nurse specialist, or other nonphysician provider. Under existing rules, the ..read more
The Hayes Blog | MDaudit
3M ago
The healthcare landscape is undergoing a potentially seismic shift, and health systems must proactively respond to the challenges and opportunities this transformation presents. This includes navigating today’s healthcare challenges with increased audit risk, systematic payer denials, and a variety of shortages being experienced across the industry.
Impact on Hospital Revenue Streams
MDaudit’s 2023 Benchmark Report has tracked a sizeable increase in patient volumes and surgical procedures in 2023. The report also noted that hospital revenue and margins ..read more
The Hayes Blog | MDaudit
3M ago
For FY2024, the Centers for Medicare & Medicaid Services (CMS) has requested $937 million for Health Care Fraud and Abuse Control (HCFAC) funding across its agencies. Of those requested funds, $238 million is earmarked for Recovery Audit Contractor (RAC) audits, a 14% increase from the FY 2023 approved budget.
The burden on hospitals and health systems is growing in tandem with CMS’s escalating audit efforts. This burden partly lands on the shoulders of health information management (HIM) professionals.
Today’s HIM departments play an integral role in the audit process. T ..read more