Revenue Cycle

The Committee identifies member issues with Medicare, Medical Assistance, and other payors regarding billing and reimbursement procedures, and works with third party payors to bring about acceptable solutions to issues raised.

The Committee also provides healthcare executives working with managed care a forum for education, communications, and networking. This forum addresses issues related to managed care policy, payor behavior, denials and appeals, clinical practice and case/disease management in western Pennsylvania.

The Committee’s Continued Focus

The Committee continues to focus on key revenue cycle performance measures, net patient revenue improvement initiatives, regulatory requirements, denial management, patient access, and uncompensated care, which includes bad debt and charity care. Current topics of discussion include observation, payor underpayment identification, payor behavior, medical assistance modernization updates and rate transparency. The Committee continues to facilitate discussions between third party payors regarding operational issues as well the impact of continuing changes from by federal and state agencies.

Recent topics of discussion have included the expansion of Medical Assistance managed care throughout Pennsylvania, audits by government and non-government payors (including Managed Care Payors, RAC, OIG, MIC and CGI), underpayments, readmissions, observation, health insurance exchanges, Managed care organizations (MCO) payment reductions, revenue benchmarking, sequestration and medical assistance (MA) modernization. This forum also gives members the opportunity to meet with payors throughout the region to discuss issues and policies.