How predictive analytics and AI shed light on payer behavior
Providers and payers have become more collaborative as payment models evolve toward value. Still, payer-provider relationships can seem one-sided — decidedly in favor of the payer — as hospitals continue to face declining reimbursement and rising costs. The increase in denials is a great example, with rates skyrocketing by 20% over 5 years, according to…
Stemming the outpatient profit squeeze with a revenue cycle workflow gap analysis
Hospital and health system outpatient, outreach and ancillary services are often confined to EHR systems to manage their billing. Designed for bigger-ticket, lower-volume claims, these systems lack specific front-end intelligence, system connectivity, and automation necessary to efficiently manage these departments’ unique billing need. Too often, the result is an unnecessarily high number of submission errors,…
Patient access: The key to a healthy revenue cycle
As hospitals and physician groups face ongoing labor shortages and skyrocketing costs, maintaining effective Patient Access processes is critical. Ensuring efficiency and accuracy upstream helps prevent delayed reimbursement downstream—while supporting a positive patient experience. Download this whitepaper to explore the three patient access processes that can help protect revenue and improve the patient experience. Identify…
4 opportunities to improve mid-cycle revenue operations
The quality of a hospital’s revenue cycle processes directly impacts the health of its bottom line. In an age of stagnant margins, hospitals should do all they can to improve revenue cycle efficiency. The mid-cycle—that critical phase between patient registration and claims submission — is a great place to start. Numerous challenges arise during this…
Denials Management Research Report
HFMA, with sponsorship from Waystar, surveyed 415 healthcare finance and revenue cycle executives to understand how denials are affecting their revenue cycle operations.
Out of the back office, into the spotlight: 5 skills revenue cycle leaders need
Healthcare has changed tremendously over the past decade. From increasingly complex payer requirements to growing federal and state regulations to a substantial change in the payer mix (patients are now the second largest payer (27%) behind the federal government (34%), which is mostly Medicare and Medicaid). Today’s revenue cycle is an entirely new animal. What…
7 KPIs providers should be tracking
Health systems and provider organizations are facing enormous challenges. In a recent poll, providers ranked five of their most pressing issues, which were staffing (58%), expenses (20%), revenue (17%), technology (2%), and other (2%), according to the MGMA. The poll also found that costs have been outpacing revenue for nine in ten respondents. In addition…
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.
Navigating payer practices to reduce denials and enhance outcomes
The friction between payers and providers has existed for decades. It’s understandable to an extent. Payers want to reduce expensive and unnecessary treatment, eliminate fraud and lower financial risk. Providers want to be able to make decisions regarding their patients’ care without having to navigate the hurdles of medical necessity, prior authorization and complex payer…
The patient as the new payer: 5 opportunities to improve the patient financial experience
Patient collections have become an increasingly difficult challenge for hospitals due primarily to a shift in payer mix. Because of rising deductibles and increased patient responsibility, the percentage of healthcare provider revenue collected directly from patients increased to more than 30% from less than 10% over ten years, according to an article from HITLeaders. Faced…