Ask the Experts

Ask the Experts

• How revenue cycle management’s security needs are evolving

  The recent cybersecurity attack on Change Healthcare has revenue cycle management vendors and clients prioritizing security and system changes.  Continue Reading

• How to measure the healthcare billing experience

  A new initiative aims to create benchmarks for the healthcare billing experience to improve patient collection rates and overall engagement.  Continue Reading

• Breaking down the FTC noncompete ban, its impact on healthcare

  The FTC recently prohibited noncompetes, a popular clause used in healthcare employment agreements, but legal challenges and clarifications are on the horizon.  Continue Reading

• How to address health equity in alternative payment models

  Aligning strategies across all healthcare stakeholders is necessary to successfully incorporate health equity into alternative payment models.  Continue Reading

• Why diversifying clearinghouse, banking partners is crucial

  In the aftermath of the Change Healthcare cyberattack, hospitals should consider diversification of clearinghouses and banking partners to reduce risk.  Continue Reading

• Why keeping private practices independent is vital

  Alliance Cancer Specialists has maintained independence from a major health system, but achieving that autonomy has been a journey.  Continue Reading

• What’s Behind Private Equity’s Interest in RCM Vendors

  New Mountain Capital’s offer to R1 RCM sheds light on private equity’s recent interest in RCM vendors, particularly outsourcing companies.  Continue Reading

• How Can Providers Establish Successful Accountable Care Organizations?

  Providers must be prepared to address patient needs across the care continuum and be equipped with proper capabilities before joining or establishing an accountable care organization.  Continue Reading

• From Pilot to Scale, Mount Sinai Leverages Autonomous Medical Coding

  Mount Sinai uses autonomous medical coding technology to code about half of pathology cases, with plans to increase volume and scale soon.  Continue Reading

• Top Trends in Automation, AI Adoption in Revenue Cycle

  Providers are energetic about automated technology in revenue cycle management, but it is not full steam ahead with adoption quite yet.  Continue Reading

• Overcoming the Barriers to Value-Based Payment in Primary Care

  Comprehensive primary care is essential to holistic health, but practices cannot make impressionable improvements without stable value-based payment and adequate resources.  Continue Reading

• How AI is Becoming a Staple in Medical Coding, Auditing

  A new partnership highlights the benefits of AI in medical coding and auditing and its inevitable use in this area of the revenue cycle.  Continue Reading

• How to Adapt as Healthcare Workforce Management Shifts

  Healthcare workforce management has changed since COVID-19, spurring organizations and candidates to rethink how they approach employment.  Continue Reading

• How a GoFundMe Page Aims to Keep a Rural Hospital Open

  A GoFundMe page for a rural hospital in PA is not only supporting local access to care but also raising awareness about the financial troubles of rural healthcare.  Continue Reading

• Key Considerations For Choosing a Revenue Cycle Technology Vendor

  Revenue cycle technology is key to improving efficiency, but success hinges on selecting the right vendor partner for the organization.  Continue Reading

• How Nursing Homes Can Prepare for Staffing Standards, Gaps

  As nursing homes wait to see if the minimum staffing standards will be finalized, they should conduct staffing reviews and ensure they have a robust compliance program.  Continue Reading

• Overcoming the Barriers to AI Adoption in Revenue Cycle Management

  Barriers to AI adoption are getting in the way of revenue cycle management success, but providers can take steps to ensure technology works for them.  Continue Reading

• Value-Based Reimbursement Grows as Providers Take on More Risk

  Fee-for-service rates stagnated as more value-based reimbursement flowed through risk-based models last year, the latest LAN data shows.  Continue Reading

• Generative AI’s Potential Shines on Revenue Cycle Management

  Generative AI is making a splash in healthcare, but its strongest use cases may be in revenue cycle management as providers look to streamline administrative tasks.  Continue Reading

• Unlocking the Future of Value-Based Care With Data

  Megan Reyna, a system VP at Advocate Health, shares how to overcome barriers to value-based care adoption and the critical role of technology.  Continue Reading

• How Vermont's All-Payer ACO Model Paves the Way for Value-Based Care

  The Vermont All-Payer ACO Model is forging a path for value-based care and reimbursement following its recent successes.  Continue Reading

• What the Latest Court Decisions Mean for the Federal IDR Process

  Two new court rulings have suspended the federal independent dispute resolution (IDR) process, although they are wins for healthcare providers.  Continue Reading

• Private Equity Acquisitions Come with Growing Antitrust Concerns

  As antitrust agencies ramp up their scrutiny of private equity acquisitions, physician practices should prepare for potential investigations before getting involved with firms.  Continue Reading

• Healthcare's Interest in Private Credit, Other Funding Sources Grows

  Private equity's reach in healthcare has been a topic of interest lately, but more providers are looking to private credit lenders and other funding sources for growth capital.  Continue Reading

• As Patient Financial Responsibility Grows, Technology Key to Collections

  Patient financial responsibility has tightened provider cash flow, but tech has helped one medical group loosen its grip by doubling daily cash collections.  Continue Reading

• Private Equity in Healthcare Is Under A Microscope, So What’s Next?

  A study reveals harmful impacts of private equity in healthcare as lawmakers debate its role, but investments aren’t likely to slow down soon.  Continue Reading

• Investments Are Needed to Implement Value-Based Care in Pediatrics

  Value-based care implementation lags in pediatrics, but investments in behavioral health and health equity can improve long-term population health for the youngest patients.  Continue Reading

• How Revenue Cycle Automation Keeps A Physician-Owned Practice Open

  Maintaining its independence is vital to the Clinics of North Texas, so the physician-owned practice turned to revenue cycle automation to optimize collections.  Continue Reading

• The Next Step in UnityPoint Health’s Revenue Cycle Technology Journey

  UnityPoint Health is moving from automation to machine learning and patient-facing tech as the health system’s revenue cycle technology journey continues.  Continue Reading

• Back to the Basics, Other Payment Integrity Strategies Post-PHE

  Fraud in healthcare isn’t as black and white as in other industries, so providers need a comprehensive payment integrity strategy after the COVID-19 public health emergency.  Continue Reading

• Key Ways the Debt Ceiling Impacts Healthcare Providers, Payments

  Patient access to care and healthcare reimbursement are on the line as lawmakers negotiate a debt ceiling agreement.  Continue Reading

• What Kaiser’s Acquisition of Geisinger Means for Value-Based Care

  The proposed acquisition between the two organizations could help encourage other health systems to pursue value-based care.  Continue Reading

• How Primary Care Acquisitions Can Advance Value-Based Care

  Primary care practices help further value-based care by generating downstream revenue for acquiring health systems and delivering quality patient care.  Continue Reading

• What Prior Authorization Changes in MA Final Rule Mean for Providers

  Healthcare organizations and experts agree that the prior authorization policies in the Medicare Advantage final rule will help reduce administrative burden on providers.  Continue Reading

• Tech Worsened Nurse Burnout, Can a New Health IT Strategy Make it Right?

  Nurse burnout is at an all-time high, leading to a recent surge in nursing strikes; hospitals need to look at their technology to ensure solutions drive efficiency while streamlining clinical workflows.  Continue Reading

• Lessons from the NSA’s Independent Dispute Resolution (IDR) Process

  A healthcare lawyer shares some surprising lessons learned from her experience with the No Surprises Act’s independent dispute resolution (IDR) process for out-of-network claims.  Continue Reading

• Long-Term Care ACOs Present an Opportunity for the Most Complex Populations

  Increasing participation in long-term care accountable care organizations (ACOs) can improve health outcomes for high-cost, high-needs populations and help accelerate the shift to value-based care.  Continue Reading

• From AI to Regulation, Making Progress with the Prior Authorization Process

  Thanks to technology the prior authorization process is less manual. However, providers are still looking for real transformation through regulation to resolve ongoing issues.  Continue Reading

• How a Better Prior Authorization Process is Rising from FHIR

  Streamlined prior authorizations are rising from the ashes after MultiCare Connected Care and Regence tap HL7 FHIR to make the process interoperable and in real-time.  Continue Reading

• How EHR-RCM Integration Can Improve Revenue Cycle Efficiency

  Partnering with a vendor that provides EHR and RCM capabilities helped one healthcare organization boost communication and improve revenue cycle efficiency for 150 care centers.  Continue Reading

• Connecting Payers, Providers, and Tech for a Better Patient Financial Experience

  Highmark Health and Allegheny Health Network are working to streamline the patient financial experience by leveraging a technology platform that involves both providers and payers.  Continue Reading

• Key Plans for Advancing Accountable Care, Value-Based Payment

  Integrating specialty care and achieving multi-payer alignment are two strategies for advancing not only accountable care as providers know it, but a new definition of the concept.  Continue Reading

• Value-Based Payment, Fee-for-Service Levels Hold Steady

  There was no significant difference in the percentage of reimbursements flowing through fee-for-service and value-based payment models from 2020 to 2021, although some payers saw greater movement.  Continue Reading

• How UT Health East Texas Addresses Healthcare’s Waste Problem

  UT Health East Texas is arming clinicians with the information to cut down on unnecessary and wasteful spending while elevating the value of patient care.  Continue Reading

• Why Text-to-Pay is a Key Resource in the Patient Collections Toolbox

  Giving patients every opportunity to pay their financial responsibility is key to success at MainStreet Family Care, and text-to-pay is a powerful resource.  Continue Reading

• Medical Coding is the Next Stop for Artificial Intelligence in Healthcare

  Industry leaders agree that artificial intelligence in healthcare is taking off; medical coding and billing is the latest use case for ER staffing company TECHealth.  Continue Reading

• 3 Trends from the Revenue Cycle Management Virtual Summit

  Patient financial experience, claim denial prevention, and new workforce trends were three concepts healthcare leaders spoke to at this year’s Revenue Cycle Management Virtual Summit.  Continue Reading

• 4 Key Areas of Value-Based Care Transformation

  With healthcare spending at an all-time high, value-based care transformation can solve the cost problem while shifting healthcare dollars so providers can focus on population health outcomes.  Continue Reading

• ACOs Improve Quality, Physician Burnout As New Opportunities Emerge

  ACOs have done more for value-based care than any other program, improving spending and quality, among other things, says CHS CMO Brian Steele. But new ACO models are causing a stir.  Continue Reading

• Healthcare Compliance Will Be a Challenge in Post-PHE World

  Leveraging fact sheets from federal agencies and reassessing healthcare compliance as soon as possible will help healthcare providers prepare for the end of the COVID-19 public health emergency.  Continue Reading

• Predictive Analytics Streamline Hospital Operations at Seattle Children’s

  Seattle Children's Hospital has cloned itself; a digital twin leverages predictive analytics in healthcare to test new processes to streamline hospital operations and save resources.  Continue Reading

• From Head in the Clouds to On the Ground Cloud-Based Revenue Cycle Management

  Healthcare stakeholders have been notoriously skeptical of cloud technology, but now providers are seeing its value through cloud-based revenue cycle management systems.  Continue Reading

• Revenue Cycle Technology Key to Patient Collections, Experience

  Patient collections is a sensitive area in healthcare, but revenue cycle technology can actually help to humanize and improve the patient financial experience.  Continue Reading

• Will Medicare Physician Fee Schedule Changes Drive Value-Based Care?

  ACO support included in the CY 2023 Medicare PFS proposed rule will boost value-based care participation only for provider groups who were already considering the shift, according to healthcare attorneys.  Continue Reading

• Bayhealth’s ERP Implementation Improves Supply Chain Management

  ERP implementation at Bayhealth has led to supply chain management efficiencies even in the face of global supply chain disruptions.  Continue Reading

• Key Challenges, Strategies for Patient-First Billing

  New laws and regulations and insurance complexities make patient-first billing a challenge for hospitals. Beth Israel Lahey Health is overcoming obstacles through people and technology.  Continue Reading

• Opportunities, Challenges of Value-Based Care Adoption

  Mount Sinai Health System is leading the value-based care adoption charge, but CEO Kenneth Davis says data is still missing to propel the entire industry forward.  Continue Reading

• More Residency Slots Could Mitigate FL's Projected Physician Shortage

  In addition to increasing the number of residency slots, Florida policymakers should expand programs that offset the costs of hosting residents to address the state’s projected physician shortage.  Continue Reading

• Efficient Data Sharing Needed for Value-Based Care Transition

  For healthcare organizations to successfully transition to value-based care, data sharing methods between providers and payers must be faster, more transparent, and done with trust.  Continue Reading

• The State of Value-Based Reimbursement, Financial Risk in Healthcare

  New data from LAN shows modest progress with value-based reimbursement adoption in 2019 and 2020. But some programs, like Medicare Advantage, are moving to financial risk faster than others.  Continue Reading

• How Providence Is Overcoming a Top Value-Based Care Challenge

  Value-based care arrangements are gaining traction, but a lack of information on patients outside of Providence St. Joseph’s system has been a major challenge.  Continue Reading

• HFMA Annual: Finance Leaders Need to Change the Culture of Medicine

  Finance leaders will need to consider care delivery changes and how the culture of medicine must shift to elevate care, says Robert Pearl at the 2021 HFMA Annual Conference.  Continue Reading

• How E/M Coding Changes Became an Urgent Problem for a TN Clinic

  AFC Urgent Care Memphis was not only hit with revenue losses from COVID-19 but also E/M coding changes. A new medical coding and billing strategy boosted revenue by 25%.  Continue Reading

• Cerner’s Next Step With Revenue Cycle Management Technology

  A new patient accounting product aims to improve consumer-oriented care and advance enterprise-wide management, bringing revenue cycle management technology to the next level.  Continue Reading

• Lessons Learned from Aetna, Cleveland Clinic’s Joint ACO Model

  Leaders from Aetna and Cleveland Clinic reflect on the first year of their joint ACO and health plan and share how others can deliver value-based care to their local markets.  Continue Reading

• As Revenue Cycle Management Expands, Automation Is Key

  Revenue cycle management is no longer just what happens in the business office, now hospitals must coordinate patient access, CDI, quality, and other aspects of care in order to get paid.  Continue Reading

• How Nebraska Medicine Turns Claims Data into Revenue Cycle Strategy

  Claims data can be used for more than reimbursement. At Nebraska Medicine, claim analytics are transforming the data into revenue cycle strategy.  Continue Reading

• COVID-19 Workflows Improve Medical Coding Efficiency Beyond Pandemic

  A system in Kansas is leveraging workflows designed to streamline COVID-19 vaccinations to improve medical coding efficiency beyond pandemic-related care.  Continue Reading

• What Revenue Cycle Can Do to Prepare for Surprise Billing Compliance

  Surprise billing compliance will have impacts throughout the revenue cycle, so preparation now is key to meeting the January 1st deadline.  Continue Reading

• How Policy, Regulation Will Challenge Consolidation in Healthcare

  A new executive order is putting consolidation in healthcare in the spotlight; industry experts share what policy and regulation will mean for provider merger and acquisition activity.  Continue Reading

• Moving to the Future of Clinical Documentation Improvement

  Michigan Medicine’s chief revenue officer sees ambient technology as the future of clinical documentation improvement, so the system is taking steps now to reach that.  Continue Reading

• COVID-19 Elevated Consumerism, How University Hospitals Is Responding

  A revenue cycle leader at University Hospitals shares the keys to success with healthcare consumerism and improving the patient financial experience.  Continue Reading

• Revenue Cycle Outsourcing Solves Staffing Challenges for AZ Practice

  When Tucson Gastroenterology faced an onslaught of staffing changes, revenue cycle outsourcing helped to fill the gaps and improve efficiencies in the process.  Continue Reading

• Value-Based Contracting 101: Preparing, Negotiating, and Succeeding

  The healthcare industry is increasingly engaging in value-based contracting; here are keys to success with these more complex payment arrangements.  Continue Reading

• Remote Patient Monitoring, Telehealth Support Value-Based Contracts

  More providers are standing up remote patient monitoring and other telehealth services in response to COVID-19 waivers. But the programs can be key to value-based contract success.  Continue Reading

• Automating Patient Financial Clearance Cuts Denials, Boosts Payments

  South County Urological has seen COB denials drop 75% and patient payments increase 15% with the help of patient financial clearance automation, much to the satisfaction of patients.  Continue Reading

• Patient Self-Service Drives Revenue Growth at Inspira Health

  Patient self-service, such as online bill pay, not only accelerated payments but also drove revenue growth to the tune of $1.5M at Inspira Health.  Continue Reading

• For Healthcare Financial Transformation, Cultural Change is Key

  Changing the culture was key to shifting from an annual to rolling budgeting process at John Muir Health as part of a healthcare financial transformation effort.  Continue Reading

• Why Patient Access is Key to Revenue Cycle Management Success

  Patient access is the first point of contact for patients and the first time staff can get key information right for revenue cycle management success.  Continue Reading

• Solving the ACO’s Out-of-Network Utilization Problem

  Technology is now driving physician referrals at one of the top Next Generation ACOs, reducing out-of-network utilization and driving better patient outcomes even during the pandemic.  Continue Reading

• Price Transparency to Digital Billing, Unlocking Financial Experience

  Carilion Clinic is not only unlocking the digital front door with price transparency but helping patients on the other side with new billing & collections options.  Continue Reading

• RCM Automation Boosts Practice’s Accounts Receivable Efficiency

  RCM automation at Key-Whitman Eye Center in Texas helped to decrease aging accounts receivable by 38% by increasing staff efficiency and prioritizing queues.  Continue Reading

• Yale New Haven Health Streamlines Patient Billing Experience

  Balancing people and technology is helping Yale New Haven Health streamline and personalize the complex patient billing experience, from registration to final bill payment.  Continue Reading

• Preparing Physician Practices for Direct Contracting, Risk Models

  Collaborative Health Systems is preparing some of its physician practice partners for Directing Contracting using technology and workflow.  Continue Reading

• How a Safety-Net Hospital Maintains a Patient-Centered Revenue Cycle

  Montefiore St. Luke’s Cornwall Hospital in New York exists to serve its community, so leaders have extended that idea to the revenue cycle.  Continue Reading

• Top Challenges, Opportunities of Medical Coding and Billing

  COVID-19 impacted every aspect of medical coding and billing, but the challenges arising from the pandemic may reveal some key opportunities for improvement.  Continue Reading

• Scale, Efficiency Key to Provider Success in 2021 and Beyond

  Increased scale and efficiency are among the many strategies speakers at the Reimbursement Virtual Summit suggested for providers to overcome the financial impact of COVID-19.  Continue Reading

• Clinicians, Tech Help St. Joseph’s Health Increase Charges by $39.6M

  The safety-net health system improved charge capture through robust clinician education and engagement, with help from revenue cycle solutions.  Continue Reading

• How Time-Driven Costing in Healthcare Boosts Staffing, Revenue Cycle

  Armed with modern data analytics, Montefiore was able to leverage time-driven costing in healthcare to first optimize staffing, then revenue cycle operations.  Continue Reading

• Making Data Sharing A Condition in Value-Based Contracts

  Data sharing is critical to delivering value, so Summit CityMD ensures it is a condition when negotiating value-based contracts with payers.  Continue Reading

• Payers, Providers Need Data to Talk Value-Based Care

  Data analytics and sharing is key to advancing the care coordination needed to achieve value-based care in a post-pandemic world, according to industry experts.  Continue Reading

• Breaking from Traditional Healthcare Budgeting During Modern Times

  John Muir Health was in the process of implementing dynamic healthcare budgeting when COVID-19 hit, but the non-traditional process actually supported health system financial stability during the pandemic.  Continue Reading

• A Specialty Group’s Revenue Cycle Automation Journey

  Revenue cycle automation has been a process, not a destination for Columbia Orthopaedic Group, and so far, automated financial clearance and A/R workflows have improved efficiency.  Continue Reading

• Court Denies Requests to Revisit 340B, Site-Neutral Payment Cases

  The cases challenged previous court decisions that upheld Medicare reimbursement cuts for 340B drugs and through site-neutral payment for hospital clinic visits.  Continue Reading

• Baptist Memorial Health Care Enhances Patient Collections with IVR

  Offering convenient payment options is key to optimizing patient collections, but a health system in Tennessee has found a way to provide that convenience whenever patients want it.  Continue Reading

• Designing Alternative Payment Models for Health System Resiliency

  The COVID-19 pandemic has been the burning platform for alternative payment models that use population-based payments for whole-person care, industry experts are saying.  Continue Reading

• How Sharp HealthCare is Winning at Revenue Cycle Management

  A gamified approach to revenue cycle management increased productivity by up to 31% in some areas, while giving staff and leadership more transparency and accountability.  Continue Reading

• Healthcare Merger and Acquisition Activity Increased in Q3 2020

  19 healthcare merger and acquisition transactions were announced in Q3 2020, up from 14 transactions in Q2 2020 and on par with historical third-quarter activity, Kaufman Hall reports.  Continue Reading

• How Revenue Cycle Technology Got Patients Back to the Office

  Patient volumes have exceeded pre-pandemic levels for Family Practice Associates of Lexington PSC thanks to patient engagement and revenue cycle technology.  Continue Reading

• A Unique IPA Centers on Social Determinants of Health

  An IPA of community-based organizations is forging contracts with payers to address social determinants of health in a way that generates ROI and sustainable programs.  Continue Reading