OUR SUCCESS
Case Management Models: Which One is Right for Your Organization?
Effective case management is central to delivering coordinated, patient-centered care. As healthcare organizations continue to evolve – especially in today’s value-based environment – selecting the right case management model is critical for improving outcomes, reducing costs, and supporting both clinical and non-clinical healthcare teams. However, with several established models out there to choose from, determining which approach best aligns with your structure, resources, and patient population can be challenging. Here is a breakdown of the most widely used case management models and guidance to help your organization make an informed decision. 1. The Brokerage Model The brokerage model is one…
Training Challenges in Ambulatory CDI—and How Organizations Can Overcome Them
As ambulatory clinical documentation integrity (CDI) programs continue to expand, many healthcare organizations are discovering that building and sustaining a well-trained outpatient CDI workforce is easier said than done. While the need for ambulatory CDI expertise is clear—particularly in risk adjustment, quality reporting, and compliance—the training infrastructure often lags behind demand. We’ve seen the same training challenges surface repeatedly across health systems, physician groups, and managed care organizations. Understanding these barriers—and how to address them—is critical for long-term program success. Challenge 1: Limited Formal Training Pathways for Ambulatory CDI Unlike inpatient CDI, which has benefited from years of standardized education…
Revenue Cycle Compliance: Staying Ahead of Payer Rules, Coding Regulations, and Healthcare Reform
Ensuring revenue cycle compliance is critical for healthcare organizations to maintain financial stability, avoid penalties, and deliver high-quality patient care. By proactively addressing evolving payer rules, coding regulations, and healthcare reform initiatives, your revenue cycle department can safeguard both revenue integrity and organizational reputation. Why Revenue Cycle Compliance Matters Revenue cycle management (RCM) encompasses every step of the financial journey in healthcare—from patient registration and insurance verification to coding, documentation, billing, and accounts receivable. Maintaining Compliance with each of these steps adheres to federal, state, and payer-specific requirements. Without strong compliance practices, organizations risk denied claims, financial losses, and reputational…
