Medical billing and collections
Medical billing and collections ensure financial stability. Patient collections bridge gaps, securing payments directly from consumers. This financial stability enables providers to maintain high-quality care, invest in IT and sustain operations, ultimately enhancing patient outcomes and the overall delivery of healthcare services.
Top Stories
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News
05 Dec 2024
High-acuity inpatient stays up 41%, likely result of upcoding
The upward trend in high-acuity hospital stays and upcoding in medical billing have yielded billions in hospital reimbursements. Continue Reading
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21 Nov 2024
For-profit hospices linked to poor care quality
Researchers discovered that hospices owned by private equity firms and publicly traded companies were linked to poorer care quality. Continue Reading
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02 Jan 2020
No Quality of Care Benefit from Hospital Acquisitions, Study Finds
Hospital acquisitions had little impact on quality of care although performance on patient experience measures declined modestly, Harvard researchers found. Continue Reading
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23 Dec 2019
Providers to Focus on Patient Billing, Policy Heading into 2020
In addition to patient billing and policy, healthcare M&A and workforce diversity will also be major trends going into the new year, according to PwC’s Health Research Institute. Continue Reading
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05 Dec 2019
National Healthcare Spending Increased to $3.6T in 2018
Higher private and Medicare coverage costs drove the 4.6% increase in national healthcare spending, while medical price growth contributed significantly, CMS actuaries report. Continue Reading
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03 Dec 2019
Patient Acquisition Hinges on Positive Medical Billing Experience
76% of healthcare consumers in a recent survey considered the medical billing experience when selecting a provider, highlighting its impact on patient acquisition. Continue Reading
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11 Nov 2019
Supporting Provider Credentialing, Payer Enrollment with a CVO
MSOs are being asked to do more with fewer resources, but a credentials verification organization (CVO) can provide much-needed support for provider credentialing and payer enrollment. Continue Reading
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28 Oct 2019
Exploring Primary Source Verification, Best Practices for Quality
Ensuring providers are qualified to deliver high-quality care through primary source verification is essential, and best practices can make the complex process simpler. Continue Reading
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18 Oct 2019
1 in 3 Americans Frustrated with Patient Billing, Collections
Healthcare consumers are unhappy with current patient billing and collection processes and they are calling for more digital, convenient options, a new survey shows. Continue Reading
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23 Sep 2019
Top KPIs Healthcare Organizations Should Track to Optimize Payer Enrollment
Tracking top KPIs is critical to evaluating payer enrollment performance and identifying opportunities for improvement in a value-based world. Continue Reading
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17 Sep 2019
Hospital Upcoding Behind Increase in Inpatient Spending in MA
In Massachusetts, commercial inpatient spending rose by almost 11 percent because of hospital upcoding and higher prices, the Health Policy Commission found. Continue Reading
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16 Sep 2019
External Claim Audits Key to Strong Hospital Compliance Programs
Strong hospital compliance programs use external claim audits to identify and correct coding and billing processes that lead to claim denials and possible fraud investigations. Continue Reading
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09 Sep 2019
Bringing Coding Compliance into the Digital Age Prevents Denials
Hospitals have relied on a relatively manual process and retrospective audits for coding compliance, but new technology is streamlining the process, allowing providers to get ahead of denials. Continue Reading
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06 Sep 2019
Healthcare CFOs Look Forward to Value-Based Care, Consumerism
Healthcare CFOs need to be strategic partners, not just financial gatekeepers, for their organizations to succeed under value-based care and other new ways of doing business. Continue Reading
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29 Aug 2019
94% of Users Would Buy Computer-Assisted Coding Solution Again
Hospitals and health systems are now realizing the benefits of computer-assisted coding solutions, a new KLAS Research report indicates. Continue Reading
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25 Jul 2019
Avoidable Hospital ED Visits Cost Healthcare System $32B Annually
Privately insured individuals have 18 million avoidable hospital ED visits a year, which are 12 times more costly than a physician office visit for the same condition. Continue Reading
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11 Jul 2019
Exploring Hospital Chargemaster Management Best Practices
Accurate codes and prices and automation are hospital chargemaster management best practices that will help hospitals weather new price transparency rules. Continue Reading
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11 Jun 2019
Hospital Financial Automation Under 25% for Most Organizations
Just 20 percent of CFOs and senior finance leaders said hospital financial automation has reached over a quarter of their processes, a new survey shows. Continue Reading
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10 Jun 2019
After EHRs, Providers Invest in Revenue Cycle Management for Success
With nearly all hospitals using an EHR, providers are now investing in revenue cycle management solutions to continue reducing costs and improving quality. Continue Reading
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03 Jun 2019
Why Healthcare Needs Price Transparency and Better Technology
Achieving meaningful price transparency will require cultural and technological changes so that providers and patients have access to actionable information. Continue Reading
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31 May 2019
Top Hospital Chargemaster Management Vendors by Hospital Use
Hospital chargemaster management vendors are supporting providers facing pressure to optimize their chargemaster in light of price transparency and revenue challenges. Continue Reading
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Answer
15 May 2019
Machine Learning Improves Patient Collections at Allina Health
Allina Health saw a $2 million patient collections boost after using machine learning to develop a propensity-to-pay model and personalized collection strategies. Continue Reading
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20 Mar 2019
NY Hospital Settles with Cerner Over $38M Medical Billing Problem
Glens Falls Hospital and Cerner agreed to settle allegations that the EHR company’s medical billing system malfunctioned and failed to send out bills in 2017. Continue Reading
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13 Mar 2019
Freestanding Emergency Departments Cost 22 Times More Than Doctor
A case study of freestanding emergency departments in Texas shows shifting care to doctors and urgent care centers could save $800 million annually. Continue Reading
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04 Mar 2019
Beth Israel, Lahey Health Finalize Hospital Merger Deal
The hospital merger deal between Beth Israel and Lahey Health creates a 13-hospital system of more than 4,000 physicians across Massachusetts. Continue Reading
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04 Mar 2019
The Benefits of a New Revenue Cycle Paradigm
Automating patient experiences, eliminating manual workflows, optimizing for outcomes, and reimagining payment methodologies will bring transformative benefits to the revenue cycle. Continue Reading
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25 Feb 2019
Employed Physicians Create Almost $2.4M a Year in Hospital Revenue
Employing physicians can significantly increase hospital revenue, but how much per specialist may indicate how successful value-based care is so far, a report shows. Continue Reading
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18 Feb 2019
3 Key Strategies to Increase Healthcare Revenue Cycle Efficiency
As providers engage in complex payment models and collect more from patients, they must learn to automate key functions to improve healthcare revenue efficiency. Continue Reading
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11 Feb 2019
Clinical Documentation and Coding Top Revenue Cycle Vulnerability
Hospitals are concerned their clinical documentation and coding processes are resulting in lost or decreased revenue, a new survey shows. Continue Reading
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11 Feb 2019
Applying AI, Automation to the Healthcare Revenue Cycle
Inefficiencies in the healthcare revenue cycle represent opportunities to apply artificial intelligence and automation when approached thoughtfully. Continue Reading
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30 Jan 2019
How Will Automation, AI Impact Healthcare Employment?
Healthcare employment will have low exposure to automation in the next decade despite the increased use of artificial intelligence to replace some tasks, experts predict. Continue Reading
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28 Jan 2019
Using Artificial Intelligence to Improve the Hospital Revenue Cycle
The use of artificial intelligence in healthcare can lead to significant improvements to the hospital revenue cycle. Continue Reading
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24 Jan 2019
Major Health Systems Create New Company to Tackle Drug Shortages
CHI’s System VP of Pharmacy shares how Civica Rx, a non-profit generic drug company, will disrupt the hospital pharmacy supply chain to solve drug shortages. Continue Reading
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30 Nov 2018
Optimizing Healthcare Workforce Management for High-Value Care
A comprehensive, sustainable healthcare workforce management strategy involves modernizing recruiting, using scheduling analytics, and lowering turnover. Continue Reading
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07 Nov 2018
Patient Leakage Costs Most Healthcare Facilities 10% of Revenue
Nearly half of healthcare organizations are losing over 10 percent of revenue because of patient leakage, yet almost a quarter do not track out-of-network patient referrals. Continue Reading
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30 Oct 2018
Aligning the Healthcare Revenue Cycle with Patient Experience
Implementing self-service technology and giving accurate price estimates is key to improving the patient experience while ensuring a smooth revenue cycle. Continue Reading
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15 Oct 2018
4 Hospital Business Models for Consumer-Centric Healthcare
Healthcare consumerism is changing how hospitals operate, resulting in new hospital business models that will help providers meet consumer demands and remain competitive. Continue Reading
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08 Oct 2018
3 Strategies to Minimize the Burden of Prior Authorizations
Automation, proactive checks, and dedicated staff are three ways that providers can reduce the negative effects of prior authorizations. Continue Reading
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25 Sep 2018
End-to-End Revenue Cycle Management Key to Success at Ascension
Implementing an end-to-end revenue cycle management solution helped Ascension standardize financial technology and best practices across its 151 hospitals. Continue Reading
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24 Sep 2018
States Look to Streamline Payer Enrollment, Cut Provider Paperwork
Arizona and Texas have implemented new rules to make it easier and faster for healthcare organizations to complete the complex payer enrollment process. Continue Reading
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17 Sep 2018
3 Patient Collections Best Practices to Boost the Bottom Line
Developing a proactive strategy, implementing payment plans, and tracking performance are patient collections best practices that help providers obtain patient financial responsibility. Continue Reading
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17 Aug 2018
Data Analytics Add Value to Healthcare Supply Chain Management
Data analytics are offering innovative healthcare systems more visibility into supply chain management issues, allowing for reduced costs and greater efficiencies. Continue Reading
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20 Jul 2018
How Hospital Merger and Acquisition Activity is Changing Healthcare
As value-based care takes over, hospital merger and acquisition activity is on the rise. But will these deals add measurable value to the industry? Continue Reading
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13 Jul 2018
Beth Israel, Lahey Health Hospital Merger May Up Costs, MA AG Says
Other hospital merger news includes the potential acquisition of Lakeland Health by Spectrum Health, Sanford Health potentially expanding east, and the final acquisition of Kindred Healthcare. Continue Reading
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11 Jul 2018
Key Terms, Components of Payer Contracts Providers Should Know
Understanding the terms and provisions in a payer contract is key to maximizing reimbursement, preventing denials, and operating a smooth revenue cycle. Continue Reading
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11 Jun 2018
Would For-Profit Hospital Ownership Improve Quality, Costs in NY?
Promoting for-profit hospital ownership in New York could improve care quality and hospital spending, which are major issues in the state, an analysis showed. Continue Reading
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04 Jun 2018
4 Strategies for Providers to Improve Hospital Price Transparency
Identifying high-volume services, posting pricing information online, and educating staff on patient financial responsibility are top ways to boost hospital price transparency. Continue Reading
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20 Apr 2018
Maximizing Provider Revenue with Payer Contract Management
Improving payer contract management by analyzing terms and assessing payer performance can maximize revenue for healthcare providers. Continue Reading
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27 Mar 2018
Transforming the Hospital Laboratory into a Profit Center
Executives oftentimes view the hospital laboratory as a cost center, but RWJ University Hospital transformed its lab by implementing an analytics-driven outreach program. Continue Reading
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23 Mar 2018
Hospital Utilization Management Can Reduce Denials, Improve Care
Comprehensive hospital utilization management programs are key to preventing claim denials and delivering the right care at the right time. Continue Reading
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02 Jan 2018
4 Key Ways to Improve Healthcare Revenue Cycle Management
Merging front and backend functions, leveraging data, collecting payments upfront, and automating prior authorizations are key to healthcare revenue cycle management excellence. Continue Reading
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14 Dec 2017
Healthcare RCM, Medicare Reimbursement Dominate 2017 Stories
Our top 10 stories from 2017 included topics on the basics of healthcare revenue cycle management and Medicare reimbursement and strategies for improving both. Continue Reading
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21 Nov 2017
Hospitals Write Off 90% More Claim Denials, Costing up to $3.5M
Claim denials jumped to the top of hospital revenue cycle challenges in the past six years along with cash flow, patient collections, and cost to collect, a survey stated. Continue Reading
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03 Nov 2017
Overcoming Rural Hospital Revenue Cycle Management Challenges
Rural hospitals face many unique revenue cycle management challenges, including health IT and value-based care. Continue Reading
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05 Oct 2017
Physician Advisors Crucial to Navigating Reimbursement Rules
Physician advisors act as a bridge between providers and other staff to improve clinical documentation, utilization review, and claim denials management. Continue Reading
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31 Aug 2017
Key Strategies for Health Systems to Achieve Economies of Scale
Selecting the right scale model and motivating facilities to work together are methods for health systems to realize savings from economies of scale. Continue Reading
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21 Aug 2017
Exploring Key Components of the Healthcare Revenue Cycle
From registration to claims management, the healthcare revenue cycle contains several independent, but connected parts that are separated by front and back end. Continue Reading
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16 Aug 2017
Top 10 Enterprise Resource Planning (ERP) Vendors By Hospital Use
Enterprise resource planning (ERP) solutions help hospitals and health systems to gain a comprehensive view of their financial health. Continue Reading
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03 Aug 2017
Top 4 Rural Hospital Challenges with Revenue Cycle Management
Physician shortages and higher uninsured rates are among the top issues rural hospitals face with improving revenue cycle management strategies. Continue Reading
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14 Jul 2017
How Providers Can Detect, Prevent Healthcare Fraud and Abuse
Providers should implement comprehensive compliance programs and improve medical billing processes to detect and prevent healthcare fraud and abuse. Continue Reading
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13 Apr 2017
Leveraging Group Purchasing for Hospital Supply Chain Management
Adopting group purchasing for medical supplies can streamline hospital supply chain management processes and reduce healthcare costs. Continue Reading
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12 Apr 2017
TN Law Aims to Make Payer Contract Management More Predictable
A new Tennessee law aims to stabilize payer contract management for providers by stopping payers from unexpectedly changing claims reimbursement rates. Continue Reading
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02 Feb 2017
4 Key Ways to Boost Point-of-Service Patient Collections
Strengthening point-of-service patient collections strategies is key to realizing full payment for healthcare services and improving healthcare revenue cycle management. Continue Reading
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04 Jan 2017
3 Most Common Healthcare Supply Chain Management Challenges
The top healthcare supply chain management challenges for provider organizations include provider preference items, a lack of supply chain health IT, and invisible costs. Continue Reading
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02 Dec 2016
Top Revenue Cycle Management Vendors and How to Select One
Epic Systems and MEDITECH topped the revenue cycle management vendor list, but the market is expected to change in the next year. Continue Reading
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04 May 2016
5 Most Common Hospital Revenue Cycle Management Challenges
Challenges of a hospital’s revenue cycle management include billing errors, IT setbacks, untrained staff and a lack of a financial policy. Continue Reading
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22 Apr 2016
Top 5 Ways to Optimize Healthcare Revenue Cycle Management
Financially clearing patients is becoming an important part of revenue cycle management, as it helps hospitals and clinics avoid debt collection. Continue Reading
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22 Feb 2016
What Are the Front-End Steps of Revenue Cycle Management?
Here is a summary of the revenue cycle management process leading up to when a patient receives care and how bad data hinders claims management success. Continue Reading
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09 Feb 2016
Why Healthcare Needs Value-Based Supply Chain Management
The ongoing shift away from fee-for-service into the value-based reimbursement realm should intensify healthcare providers’ focus on supply chain management. Continue Reading
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28 Oct 2014
Examining the Basics of the Healthcare Revenue Cycle
Managing the healthcare revenue cycle is about more than just collecting bills. Organizations must master these basics if they wish to build a successful financial future. Continue Reading