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 [...]

While each health center is in varying stages of the COVID-19 battle, one underlying goal is on all our minds – how do we safely re-open our facilities to patients who need in-person care?

COVID-19 continues to disrupt every aspect of the healthcare revenue cycle landscape and, as a leader, you need to maintain awareness of countless regulatory adjustments, but also the broader impact on your employees and patients. In the billing space [...]

Have you recently found yourself with a partially or fully remote team? Are you looking for ways to engage and communicate with your team members? If so, virtual huddle boards may be the solution you are looking for. As a former Patient Access Director, [...]

As we all navigate uncharted waters with this unprecedented pandemic, we are working to identify best practices and considerations specific to the revenue cycle. While we continue to see variation around billing guidelines from payers, the following list [...]

A point of pride for The Wilshire Group is sharing our lessons learned with the community at large – whether you are a present, past, prospective customer or a healthcare system working to adapt to the changes facing us all right now.While the darkness [...]

It’s hard to overstate the disruption that our nation is experiencing from both personal and business standpoints. One of the most significant changes is the mass exodus of workers from the office to the home. Different employers have different [...]

An incredible amount in our daily lives has changed in the last few weeks as the country ramps up social distancing to slow the spread of COVID-19. Our clients’ daily lives are also rapidly changing to meet the demands of the pandemic. Whether it’s [...]

In today’s word of shrinking reimbursement and consumer driven healthcare, having a top performing Patient Access operation to attract patients, keep them in system, and ensure you are paid for all services provided is more important than ever.