On July 1, a CMS rule requiring prior authorization for certain hospital outpatient procedures goes into effect.The rational for why CMS is instituting this change is summarized below. 

Reducing hospital readmissions has been a longstanding goal for most health systems and theHospital Readmissions Reduction Program (HRRP)formalized this goal by creating incentives (and penalties) for reducing readmissions for certain diagnosis.Now w [...]

COVID-19 seems to be bringing about day-to-day and even hour-to-hour changes to your operations as both best practices and regulations are adjusted. In Part One of our deep dive, we talked about best practices you can implement now to help you continue [...]

It’s that magical time of year when we receive our annual gift from Medicare with the Hospital Outpatient Prospective Payment System (OPPS) final rule. Pricing Transparency is a focus yet again and is the gift that keeps on giving. A link to the final [...]

Our blog post this week focuses on the recent executive order on pricing transparency. Two of our experts, Andrew Wade and Matt Perron, ask each other a few questions on what this could mean for healthcare organizations and what they could be doing to [...]

In our March Newsletter, the Wilshire Group introduced Quick HITS – short term, focused projects designed to maximize your ROI. We are happy to announce our first patient access focused project, Registration and Authorization Quality!

We all know that quality registration forms the bedrock for a high-quality revenue cycle.

Two weeks ago, we discussed general RTE optimization with Epic. Today, we will be doing a deeper dive into RTE and how it can impact front-end payment collection.

Many errors in the revenue cycle can be attributed to not selecting the appropriate insurance plan during registration. One recent presentation at the annual NAHAM conference cited that 20% of registration-related denials were due to coverage and Real [...]

The Wilshire Group is proud to announce our Patient Access Services Division. We bring 20+ years of Patient Access IT, operational, and consulting experience and specialize in helping clients get the most out of Epic and their front-end processes.