How one health system focused on revenue cycle staff education to improve its denial rate
Many longtime revenue cycle leaders can recall a simpler time when insurance companies sold plans that were broadly accepted by providers in their service areas. Back then, hospitals provided services to patients, billed their health insurance plans and expected relatively prompt payment. This is no longer true. Today’s revenue cycle team members must be knowledgeable…
What health systems need to know about partnering to develop an ASC strategy
Health systems must contend with conflicting imperatives. While remaining intensely focused on day-to-day operations and financial viability, they cannot ignore longer-term strategic imperatives, which may include building out a full continuum of care to succeed under value-based payment while maintaining market relevance. Yet many health systems face significant impediments to broadening the continuum of care,…
The key role of downside risk in the success of value-based care
The basic idea behind value-based care (VBC) is simple. By encouraging providers to focus on the value rather than the volume of the services they deliver, it should be possible to achieve the twin goals of lowering healthcare costs and improving clinical outcomes. Given that the United States now spends far more per capita on…
Lessons learned from the Change experience
As is now well known, Change Healthcare, a 2022 acquisition by UnitedHealth Group (UHG), was hacked this past February. For nine days, hackers were able to gain access to and maneuver through Change Healthcare’s files at will before it became clear that the system had been compromised. According to a report from the Congressional Research…
A new DOJ task force is the latest example of intensified federal oversight of healthcare antitrust issues
A new task force at the U.S. Department of Justice (DOJ) is likely to bring additional scrutiny on whether healthcare transactions adversely affect competition. The department’s Antitrust Division announced the formation of a group to “consider widespread competition concerns shared by patients, healthcare professionals, businesses and entrepreneurs, including issues regarding payer-provider consolidation, serial acquisitions, labor…
Healthcare Blame Game: What media and lawmakers don’t understand about hospital finances
In this episode, HFMA policy director Andrew Donahue discusses margins, investments and M&A and what measure tells the real story of hospital finance.
Maryland’s example is no solution to healthcare’s true crises
In the wake of Medicare’s enactment in 1965, healthcare costs in the United States began rising at double-digit rates annually.a Many policy experts blamed hospital costs, which by 1980 had reached almost 41% of health spending.b It was believed that if you contained hospital costs, overall health spending would come under control. In 1974, the…
Hospital payments have been substantially affected by the Change Healthcare cyberattack, report finds
Newly published data reflect the extent of the payment loss experienced by hospitals and health systems during the first month or so after the Change Healthcare cyberattack. A report (registration required) published in mid-May by Strata finds that gaps in expected revenue ranged from 16.5% to 17.9% per hospital for Q1. The insights were culled…
U.S. Bank 2023 Healthcare Payments Insight Report
In this infographic, learn about 2023 Healthcare payments trends.
Closures of Walmart’s health centers reflect the widespread financial constraints in U.S. healthcare
Beyond signaling a setback for retail-based healthcare disruptors, Walmart’s recent decision to close its health centers is symptomatic of issues hampering the nation’s ecosystem for primary care, industry analysts say. The retail behemoth announced April 30 it would be closing all 51 of its health centers across five states, along with its virtual-health service. Five…