Articles and Links
Retrospective Review
The good, the bad and the ugly
Kirk A. Abbott, Ph.D. and Jennifer Keller, RN, MBA
25 December 2005, Revised 12 February 2006
Retrospective review of managed care accounts is a critical component in hospital revenue cycle management. Today, a rigorous retrospective review (or retro) must be considered a mandatory activity, not only maximizing the collection of due net revenues but also to ensure government compliance, managed care contract compliance and perhaps most importantly to set the stage for future effective contract negotiations. Incorporating resources to leverage on technical and process advancement will give rise to retro performance. This article discusses best practices for performing a successful retro, a key tool in a hospital’s financial management repertoire.
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(pdf file, 282kb)
No Small Change
Payment Trends Call For Big Preparations For 2006
Martin J. D’Cruz and Terri L. Welter
December 2005
Payment trends that hospitals will need to respond to in 2006 are related to five areas of concern: The need to audit commercial insurers’ payment for accuracy, The need for contract modeling and data-driven organization, The shift of volume risk from payers to hospitals, The shift of cost risk from payers to hospitals, The rise of consumer-directed health plans and related pay-for-performance and tiered pricing initiatives. Payment trends in 2005 posed severe challenges for hospitals due to changing payment methods and increased denials and underpayments. What trends should you look to in 2006 to protect your financial performance?
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(pdf file, 56kb)
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