The impact of claims denials on the financial health of healthcare
While their hospitals and healthcare centers have long had to deal with claims denials, the number of denied claims continues to rise and payers are showing little inclination to help solve the problem, according to several roundtable participants.
Monument Health revamps its revenue cycle leadership structure for the benefit of patients and the organization
Looking to break through the cultural silos that can hamper operations at hospitals and health systems, Monument Health has engineered a new brand of clinical-finance collaboration. Headquartered in Rapid City, South Dakota, the community-based health system established a dyad leadership structure in which a clinical leader has joint oversight of the revenue cycle. It’s a…
News Briefs: 2023 brings a steep fee hike for No Surprises Act arbitration cases
The No Surprises Act’s independent dispute resolution (IDR) process has become more expensive for healthcare stakeholders. For the new year, the nonrefundable administrative fee due from each party involved in any payment dispute that goes to arbitration increased from $50 to $350, according to a Dec. 23 memo from CMS’s Center for Consumer Information and…
Key points to know in recently proposed rules for Medicare Advantage and the ACA marketplaces
A proposed rule for health plans in Medicare Advantage has provisions designed to stem overreach in prior authorization processes.
Labor costs and other concerns dampen the outlook for not-for-profit hospitals this year
Insights from a leading credit-rating agency illustrate the scope of the financial challenges facing not-for-profit hospitals in 2023.
How healthcare organizations can defend against financial hazards in 2023
What are the most critical strategies to steer healthcare organizations in the direction of financial stability in the following year and beyond? A couple tips include reducing bad debt and accessing external benchmarks for supply pricing.
Utilization Review: 5 Reasons Hospitals Lose Revenue
An effective utilization review program must revolve around the right management and processes as well as communication among teams.
Improve cash flow and cost of reworking denials with the efficientC claim scrubber technology
In five years’ time, denial claims have shot up 20%. Learn about a decision support and claims management technology platform that stops claims before they get denied.
PMMC’s Contract PRO helps hospitals see an average 10 to 1 ROI
When the time comes to renegotiate payer contracts, one company’s contract management system “provides managed care leaders with the ability to model all commercial payer contract terms to quickly understand the impact on net revenue.”
Delivering scalable, patient-focused revenue cycle management services
A revenue cycle management company talks about the importance of experience, versatility, and customer service when responding to current and emerging revenue cycle challenges.