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
12 Nov 2024
Physician compensation totals 84% of medical group expenses
Medical groups might rethink operations in light of new Kaufman Hall data about physician compensation and overall employee investment/subsidy. Continue Reading
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01 Nov 2024
CMS, CFPB take on improper medical collections in Medicare
CMS and CFPB have issued a joint statement outlining prohibitions against medical debt collection for Medicare members exempt from cost-sharing. Continue Reading
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10 Apr 2023
61% of Providers Plan to Outsource Revenue Cycle Management Tasks
When outsourcing revenue cycle management tasks, providers are most focused on finding vendors that have proven their ability to accelerate cash flow and exhibit excellent customer service. Continue Reading
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10 Apr 2023
Clinician-Owned Practices Improve Quality Without the Burnout
A recent study suggests cultural features of clinician-owned practices are linked to quality improvements without increased levels of burnout among staff. Continue Reading
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07 Apr 2023
KLAS: Healthcare Orgs Satisfied with Eligibility, Enrollment Services
Elevate Patient Financial Solutions received the highest overall performance score regarding eligibility and enrollment services provided to healthcare organizations, KLAS reported. Continue Reading
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06 Apr 2023
How Do Rural Hospitals Survive When Facing Financial Instability?
Between 2010 and 2018, 77 percent of rural hospitals experiencing financial instability remained open without merging, 7 percent faced closures, and 17 percent merged. Continue Reading
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05 Apr 2023
Hospital Chargemaster Heavily Influences Cash Prices, Payer Rates
A new study found cash prices and commercially negotiated rates were both consistently discounted from hospital chargemaster rates, with self-pay being the cheapest option. Continue Reading
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30 Mar 2023
More Hospital CEOs Are Leaving Their Posts
The number of CEO changes across industries is rising, with healthcare being hit particularly hard compared to last year. Continue Reading
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29 Mar 2023
Hospital Margins Still Negative, But Finances See Some Stability
Kaufman Hall reports that the median year-to-date operating margin index for hospitals was -1.1% in February, down from just -0.8% the previous month. Continue Reading
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28 Mar 2023
Healthcare Employment, Spending Continues to Grow in 2023
National healthcare spending rose by 4.6 percent compared to last year, while healthcare employment growth was driven by hospitals, which added 19,400 jobs in February 2023. Continue Reading
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24 Mar 2023
Physician Compensation Fell, Gender Pay Gap Persisted in 2022
The physician compensation gap between women and men was 26 percent in 2022, with women physicians earning almost $110,000 less than their male counterparts. Continue Reading
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23 Mar 2023
Hospitals Ask Lawmakers for Well-Being, Workplace Safety Support
The American Hospital Association wrote a letter to Congressional leaders with a legislative wishlist for supporting the healthcare workforce amid rising burnout rates and violence in EDs. Continue Reading
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22 Mar 2023
Two-Thirds of Patients Have Never Challenged a Medical Bill’s Accuracy
Among uninsured individuals, 78 percent reported never disputing a medical bill with their physician, hospital, or insurance company. Continue Reading
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22 Mar 2023
Healthcare Has Yet to Feel Full Impact of Physician Retirements
A new survey indicates that many physicians still plan to retire early after the COVID-19 pandemic despite growing economic concerns. Continue Reading
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21 Mar 2023
AMGA: FTC Non-Compete Agreement Ban Will Hurt Healthcare Workforce
Non-compete agreements help maintain patient-provider relationships and enable medical groups to strengthen the healthcare workforce by investing in physician recruitment, AMGA said. Continue Reading
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20 Mar 2023
Patients with Alzheimer's Disease See Higher Hospital Readmission Rates
The 30-day hospital readmission rate was 6.8 percentage points higher for patients with Alzheimer’s disease and related dementias compared to the general senior population. Continue Reading
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20 Mar 2023
AHA: Financial Assistance One Piece of Hospital Community Benefits
The American Hospital Association (AHA) is defending the community benefits hospitals provide after a recent analysis shows nonprofit hospitals’ tax exemptions exceed their charity care costs. Continue Reading
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17 Mar 2023
Emergency Department Labor Costs Up 50% From Pre-Pandemic Levels
Hourly wages for registered nurses represented a significant share of total emergency department labor costs in January 2023, the report found. Continue Reading
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15 Mar 2023
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
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14 Mar 2023
Past-Due Medical Debt Impacts Over 1 in 7 Adults
A new report shows that past-due medical debt to healthcare providers particularly affects lower-income families, with most owing at least some hospital debt. Continue Reading
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Feature
14 Mar 2023
How Walmart Became a Major Player in the Healthcare Industry
As Walmart Health expects to nearly double its healthcare footprint, the company is prioritizing community needs and affordable care—the notions that helped solidify its place in the industry. Continue Reading
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13 Mar 2023
Hospital Contract Labor Expenses Jump 258% As Shortages Persist
Nationwide labor shortages in 2022 resulted in higher hospital contract labor expenses as hospitals sought to meet patient demand, a report from the AHA shows. Continue Reading
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08 Mar 2023
MEDITECH Leads Patient Accounting Vendors for Small Hospitals
Small hospitals are changing their EHR and patient accounting systems more than their larger peers; most are going to Oracle Health, MEDITECH, and Epic. Continue Reading
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07 Mar 2023
COVID-19 Vaccination Requirements Boosted Uptake Among NYC Municipal Workers
The vaccination prevalence among NYC municipal workers increased from 485.5 to 834.9 per 1,000 employees across seven months after the city implemented COVID-19 vaccination requirements. Continue Reading
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06 Mar 2023
4 Common Surgeries Shifted to Outpatient During COVID-19
A study finds that outpatient surgery rates for 4 common procedures rose significantly during the pandemic, while barriers prevent greater uptake for other surgical operations. Continue Reading
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03 Mar 2023
Outpatient Sector Saw the Most Private Equity Investments in 2022
The increase in private equity investments has generated concerns about cost-cutting tactics that adversely impact patient care. Continue Reading
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02 Mar 2023
Hospital Execs Expect Greater Shift to Outpatient Care
Care has been shifting from inpatient to outpatient settings; hospital and health system executives anticipate even more outpatient volumes in 2023. Continue Reading
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02 Mar 2023
SNF Vertical Integration Tied to Higher Utilization, Fewer Readmissions
The skilled nursing facility (SNF) utilization rate among hospital networks with SNF vertical integration was 21.7 percent compared to 19.7 percent for networks without integration. Continue Reading
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01 Mar 2023
Hospital Financial Performance Still Lags Behind 2020
Hospital financial performance may be hitting a new normal as operating margins improve but remain negative, Kaufman Hall reports. Continue Reading
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01 Mar 2023
Medicaid Expansion Tied to Fewer Financial Challenges for Rural Hospitals
Between July 2019 and June 2021, the median operating margin was 8.5 percent for rural hospitals in states that had adopted Medicaid expansion, compared to 5.6 percent for those in non-expansion states. Continue Reading
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28 Feb 2023
Negotiated Prices for Surgical Procedures Higher in Hospital Networks
The median negotiated price for shoulder arthroscopy was $4,432 at facilities participating in a hospital network compared to $2,643 at independent hospitals. Continue Reading
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27 Feb 2023
Court Rejects Property Tax Exemptions for 4 PA Non-Profit Hospitals
The Pennsylvania Commonwealth Court ruled against the four non-profit hospitals because they could not prove they were operating as purely public charities. Continue Reading
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27 Feb 2023
KLAS: Workday, Oracle Receive Top Scores for Cloud-based ERP Services
Among cloud-based ERP vendors, Workday received the top overall performance score of 86.5 on a 100-point scale, followed by Oracle, which received a 79. Continue Reading
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23 Feb 2023
Staffing Experts Share How Hospitals Can Improve Workforce Management
Investing in technology that prioritizes interoperability and cybersecurity is one way hospitals can improve workforce management in 2023. Continue Reading
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22 Feb 2023
Medical Billing Companies Spill About Outsourcing Operations
A recent survey of medical billing companies shows a positive outlook on revenue cycle outsourcing, with many seeing payment collection as an opportunity. Continue Reading
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21 Feb 2023
CMS Eyes Stricter Enforcement of Hospital Price Transparency Compliance
CMS officials report that hospital price transparency compliance has improved over 2 years; more “aggressive additional steps” to identify noncompliance can help, they say. Continue Reading
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17 Feb 2023
Workforce Challenges Remain a Top Concern for Healthcare Executives
Healthcare executives ranked workforce challenges as their top issue, specifically reporting concerns about registered nurse and technician shortages. Continue Reading
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14 Feb 2023
KFF Study: Hospital Price Transparency Data Messy, Inconsistent
A study from KFF finds that hospital price transparency data shared with the public varies widely and crucial information for patients and researchers is missing. Continue Reading
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13 Feb 2023
REH Designation May Help Small Share of Rural Hospitals Avoid Closure
While the Rural Emergency Hospital (REH) designation aims to help rural hospitals avoid closure, it requires facilities to forgo all inpatient services and maintain a staffed emergency department. Continue Reading
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08 Feb 2023
Only 25% of Hospitals Are Complying with the Price Transparency Rule
Over 1,500 hospitals reviewed in the report were noncompliant with at least one requirement of the price transparency rule between December 2022 and January 2023. Continue Reading
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08 Feb 2023
Higher Spending on Nursing Home Staff is Not Tied to Better Staffing Levels
Nursing homes with a high Medicaid payer mix had the lowest staffing levels of 3.32 hours worked but spent a higher share of their revenue on staff compared to other facilities. Continue Reading
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03 Feb 2023
GAO: CMS Nursing Home Ownership Information Lacks Transparency
The CMS nursing home ownership information on the Care Compare website uses confusing terminology and does not allow consumers to identify common ownership and quality across facilities, GAO found. Continue Reading
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02 Feb 2023
Automating Claims Management Processes May Reduce Costs for Providers
The adoption of electronic transactions increased in 2021, but further automation of claims management processes could save healthcare providers nearly $25 billion annually. Continue Reading
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01 Feb 2023
US Sees Highest Healthcare Spending But Worst Health Outcomes
The US is the only high-income country that does not guarantee health insurance coverage to residents, which has led to high healthcare spending and poor health outcomes. Continue Reading
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31 Jan 2023
Locum Tenens Clinicians Experience Lower Burnout Levels than Physicians
More physicians expressed interest in becoming locum tenens clinicians, with 73 percent interested in local contract work and 63 percent open to locum tenens positions that require travel. Continue Reading
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31 Jan 2023
Plagued by High Expenses, Half of Hospitals Finish in the Red
2022 has shaped up to be the worst for hospitals and health systems since the start of COVID-19. Continue Reading
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30 Jan 2023
Private Equity Ownership of Rural Hospitals is Growing, Report Finds
In addition to acquiring rural hospitals, private equity firms are frequently investing in rural healthcare companies that provide emergency care, behavioral healthcare, and travel nurses. Continue Reading
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30 Jan 2023
Patients Face Higher Healthcare Spending, Prices at Health Systems
Commercial prices for outpatient visits were 26 percent higher for patients receiving care at a health system than those visiting non-system physicians and hospitals. Continue Reading
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27 Jan 2023
AMGA: Medical Groups Faced Workforce Challenges, High Expenses in 2022
Workforce challenges persisted for medical groups in 2022 as the number of clinical staffing FTEs fell by 11.3 percent and staffing expenses rose by 15 percent. Continue Reading
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26 Jan 2023
KLAS: Orgs Value Functionality from Claims Management Vendors
Organizations cited nickel-and-diming and poor customer support as reasons for replacing their claims management vendor. Continue Reading
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25 Jan 2023
Caring for Opioid Use Disorder Patients Costs Hospitals $95B Per Year
Hospital costs among patients with opioid use disorder diagnoses were 32.5 percent higher for emergency department visits and 8 percent higher for inpatient admissions. Continue Reading
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25 Jan 2023
Intermountain Healthcare Rebrands, Drops “Care” In Name
UT-based Intermountain Healthcare will now be known as Intermountain Health to emphasize the health system’s role in keeping people healthy. Continue Reading
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24 Jan 2023
Just A Few Health Systems Dominate Medicare Inpatient Spending
Only two health systems account for the majority of Medicare inpatient spending in 10 states plus DC, sparking concerns over market consolidation and Medicare prices. Continue Reading
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24 Jan 2023
Higher Surgical Volume Led to Better Patient Outcomes, Lower Costs
The total costs for hip and knee replacements were $2,800 and $1,500 lower when the procedures were performed by a surgeon with a high surgical volume compared to one with a low surgical volume. Continue Reading
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23 Jan 2023
Significant Staffing Challenges Continue for Nursing Homes
Without long-term investments to address staffing challenges, the nursing home workforce will not return to pre-pandemic levels until 2027, AHCA/NCAL projected. Continue Reading
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23 Jan 2023
UPMC Shifts Site To An Outpatient Emergency Department
UPMC Lock Haven will be an outpatient emergency department under Pennsylvania’s new Innovative Hospital Models project, sparking concerns from locals. Continue Reading
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20 Jan 2023
Medicaid Expansion Helped Improve Provider Financial Performance
Medicaid expansion improved financial performance for healthcare providers and was associated with lower uncompensated care costs and higher revenues. Continue Reading
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19 Jan 2023
Healthcare Bankruptcies Grew by 84% in 2022, Returning to 2020 Levels
There were 46 healthcare bankruptcies with liabilities of $10 million or more in 2022, rising from 25 case filings in 2021. Continue Reading
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19 Jan 2023
Healthcare Private Equity Down But Not Out, Report Finds
2022 was the second biggest year on record for healthcare private equity despite an uncertain and inflationary market hampering activity by the end of the year. Continue Reading
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18 Jan 2023
People Have Less Trouble Paying Medical Bills, But Concerns Remain
A new HHS report shows that fewer people report having trouble paying their medical bills, but the agency maintains that the burden of healthcare costs is still a public health concern. Continue Reading
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17 Jan 2023
AAMC: Gender and Racial Diversity On the Rise in US Physician Workforce
Over a third of the active physician workforce in 2021 were women, and the number of Black and Hispanic matriculants in medical school increased during the 2022-23 school year. Continue Reading
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16 Jan 2023
Healthcare Mergers and Acquisitions Regain Momentum
A new analysis from Kaufman Hall records 53 announced healthcare mergers and acquisitions in 2022 and historically high transaction revenues. Continue Reading
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13 Jan 2023
Elective Surgeries Shifted from Inpatient to Outpatient Settings
The cost of receiving a total knee arthroplasty in outpatient settings was 22 percent lower than the cost at inpatient facilities. Continue Reading
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12 Jan 2023
Consumers are Frustrated with Healthcare Billing Correction Process
Almost 45 percent of consumers reported spending up to one month on the healthcare billing correction process. Continue Reading
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11 Jan 2023
Practices Experience Staffing Changes After Private Equity Acquisition
A new study shows that physician practices undergoing private equity acquisitions experience more workforce changes, including higher clinician replacement and APP ratios. Continue Reading
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09 Jan 2023
Affordability, Labor Shortages Top Issues for Healthcare Execs
2023 will be a year of “reckoning and restructuring,” according to PwC, as healthcare executives face growing labor shortages while trying to address rising costs and disruptors. Continue Reading
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09 Jan 2023
VillageMD Completes $8.9B Acquisition of Summit Health-CityMD
The $8.9 billion acquisition deal will form a medical group with more than 680 provider locations in 26 markets. Continue Reading
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05 Jan 2023
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
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05 Jan 2023
Financial Challenges for Health Systems Will Likely Persist in 2023
While health systems expect to face ongoing financial challenges due to inflation and rising costs, health plan leaders are prioritizing the shift to value-based care. Continue Reading
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04 Jan 2023
Hospital Margins Improved in November But Remained Negative
Hospital margins increased by 12 percent from October to November due to declining expenses, but operating margins remained negative at -0.2 percent. Continue Reading
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04 Jan 2023
Orgs Need to Be More Competitive to Keep Advanced Practice Providers
Advanced practice provider compensation is growing rapidly as organizations face ongoing staff shortages and other healthcare workforce challenges. Continue Reading
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03 Jan 2023
Financial Losses, Poor Assets Driving Closure Risks for Rural Hospitals
Of the over 600 rural hospitals facing closure risks, more than 200 facilities are at immediate risk of closing and have more debts than assets. Continue Reading
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30 Dec 2022
Nurse Practitioners Have Lower Productivity than Physicians, Study Finds
Relative to physicians, nurse practitioners increased length of stay by 11 percent and raised the cost of emergency department care by 7 percent. Continue Reading
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29 Dec 2022
Share of Unionized Healthcare Workers Remained Low for 12 Years
Labor unionization was associated with better pay and benefits, with unionized healthcare workers reporting mean weekly earnings of $1,165 compared to $1,042 for nonunion workers. Continue Reading
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28 Dec 2022
Exploring the Role of Supply Chain Management in Healthcare
Healthcare supply chain management leaders are looking to become more efficient and resilient as they continue to face significant supply chain disruptions. Continue Reading
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23 Dec 2022
Providers Tap Vendors to Support Rolling Forecasting Transition
More healthcare organizations are moving away from static yearly budgets to gain the flexibility of rolling forecasting; two vendors are standing out to help with the transition. Continue Reading
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21 Dec 2022
Physician Work Hours Declined 7.6% Over the Last Two Decades
The consistent decline in physician work hours was offset by the rapid increase in work hours contributed by the advanced practice professional workforce. Continue Reading
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20 Dec 2022
KLAS: athenahealth, NextGen Lead in Practice Management Success
athenahealth solutions earned a top practice management performance score of 92.6 among large practices and 80.6 among midsize practices. Continue Reading
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19 Dec 2022
Ascension to NYT: We Are Committed to Nurse Workforce Culture
A recent New York Times article accused Ascension of igniting its nurse workforce challenges by putting profits over its staff before the COVID-19 pandemic. Continue Reading
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19 Dec 2022
Medical Bills Are Confusing for Nearly 40% of Adults, Survey Finds
Respondents said that getting a call from their provider before receiving care that explains payment expectations and financial assistance options would help them understand their medical bills better. Continue Reading
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14 Dec 2022
Experts Predict Strong Merger and Acquisition Activity for 2023
Merger and acquisition activity in the health services sector was generally lower in 2022 compared to prior years, but PwC researchers anticipate increased divestitures in 2023. Continue Reading
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12 Dec 2022
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
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09 Dec 2022
AHA: Delayed Discharges Led to 19% Increase in Patient Length of Stay
AHA asked Congress to provide per diem Medicare payments as hospitals grapple with the increase in patient length of stay and inadequate reimbursement. Continue Reading
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08 Dec 2022
OIG: Labs Billed Medicare Part B for High Levels of Diagnostic Tests
Medicare Part B paid labs more than $67 million for potentially fraudulent add-on tests included on claims for COVID-19 tests during 2020. Continue Reading
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06 Dec 2022
For-Profit Health System Operating Margins Exceed Pre-Pandemic Figures
For-profit health systems HCA Healthcare, Tenet Healthcare Corporation, and Community Health Systems have all had positive operating margins for most quarters during the pandemic. Continue Reading
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05 Dec 2022
Atrium Joins Advocate Aurora in Hospital Mega-Merger Deal
The two health systems have finalized a $27B hospital mega-merger, creating the fifth-largest nonprofit integrated health system in the nation. Continue Reading
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01 Dec 2022
Patient Payment Solutions Not Living Up to Provider Expectations
30% of providers feel patient payment solution implementations were not successful and just 58% are highly satisfied with their current solution, new data shows. Continue Reading
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01 Dec 2022
Rising Expenses, Negative Margins Drove Poor Hospital Finances
Hospitals saw rising expenses and negative margins again in October, with the average operating margin falling 2 percent to -0.5 percent. Continue Reading
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30 Nov 2022
Inflation Driving Financial Challenges for Consumers, Health Systems
Almost a third of consumers cited inflation as their top reason for being concerned about covering unexpected healthcare costs. Continue Reading
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28 Nov 2022
Sanford Health, Fairview Health Systems Plan to Form Integrated Health System
The non-binding letter of intent expressed plans to form an integrated health system combining Sanford Health’s experience caring for rural communities and Fairview Health Services’ background in serving urban populations. Continue Reading
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23 Nov 2022
CMS Offers Up New Hospital Price Transparency Resources
The federal agency released 3 voluntary sample formats to assist with hospital price transparency compliance, which still remains spotty. Continue Reading
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22 Nov 2022
Butler Health System, Excela Health Enter Definitive Merger Agreement
The definitive merger agreement signals the start of regulatory approvals to create a five-hospital system that would generate over $1 billion in revenue. Continue Reading
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22 Nov 2022
22 States Want CMS to Repeal Healthcare Vaccine Mandate
A coalition of states led by Montana AG Austin Knudsen argues that the justification for the “rushed” healthcare vaccine mandate has disappeared. Continue Reading
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21 Nov 2022
MGMA Requests Modifications of Good Faith Estimate Requirements
MGMA stressed the importance of developing, testing, and implementing workable solutions before HHS enforces the advanced explanation of benefits and good faith estimate requirements. Continue Reading
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18 Nov 2022
Younger Primary Care Physicians Seeing High Levels of Burnout, Stress
Half of primary care physicians under 55 reported experiencing burnout, but only 16 percent sought professional help for their mental health concerns since the pandemic began. Continue Reading
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16 Nov 2022
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
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16 Nov 2022
NYC Nonprofit Hospitals Saw High Tax Breaks, Low Community Investments
NYC nonprofit hospitals received $1.5 billion in tax breaks and spent $1.1 billion on community investments in 2019, with the highest fair share deficit for a single hospital amounting to $359 million. Continue Reading
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15 Nov 2022
Providers Vary When Measuring Return on Investment of RCM Automation
Almost a third of healthcare financial leaders said they calculate the return on investment of revenue cycle management in-house, while 7.4 percent said their vendor calculates it. Continue Reading
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15 Nov 2022
House Committee Urges GAO to Examine Hospital Price Transparency Compliance
Specifically, the House Committee on Energy and Commerce asked GAO to look into hospital compliance with the machine-readable file and consumer-friendly format requirements of the hospital price transparency rule. Continue Reading
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14 Nov 2022
ACEP Urges Biden Admin to Address Emergency Department Boarding
In addition to impeding patient access to timely care, emergency department boarding increases physician burnout and exacerbates staffing shortages. Continue Reading
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10 Nov 2022
Increase in Cross-Market Hospital Systems May Hurt Market Competition
The number of cross-market hospital systems that could exert enhanced market power and harm competition increased from 37 to 57 between 2009 and 2019. Continue Reading
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08 Nov 2022
Aggressive Medical Debt Collection, Other Proposed Never Events
Some industry experts have come up with 5 new hospital “never events,” including aggressive medical debt collection and paying employees less than a living wage. Continue Reading