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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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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07 Nov 2022
KFF: Varying Hospital Charity Care Policies Influence Spending
Some hospitals are subject to state charity care policies as well as federal regulations, which may lead to higher charity care spending, KFF said. Continue Reading
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07 Nov 2022
Financial Challenges Persist for Hospitals, Physicians in September
Hospital expenses fell 1 percent in September, but it was not enough to offset the 4 percent decline in operating revenue, allowing financial challenges to persist. Continue Reading
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03 Nov 2022
COVID-19 Labor Shortages Impacted Reproductive Health Workforce
COVID-19 labor shortages in healthcare already shifted access to contraception and abortion services years before the Roe v. Wade decision. Continue Reading
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31 Oct 2022
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
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31 Oct 2022
More Hospitals Complying With Price Transparency Rule Requirements
Compliance with hospital price transparency rule requirements may be increasing, as 55 percent of hospitals had complete machine-readable files with cash, list, and negotiated rates for services. Continue Reading
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28 Oct 2022
OR Nonprofits Impede Patient Access to Financial Assistance Programs
Oregon nonprofit health systems had complex application processes and used vague language in their policies, impeding patient access to financial assistance programs. Continue Reading
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27 Oct 2022
Rapid Recovery Unlikely as Hospitals Face Worst Financial Year Yet
Economists from Johns Hopkins say hospitals will have to enact “aggressive cost-cutting measures,” including department or service line closures, to stabilize profit margins. Continue Reading
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27 Oct 2022
Consumers are Unaware of Available Financial Assistance for Medical Bills
Financial assistance programs can help consumers manage their medical bills, but 64 percent are unaware of these resources, a survey found. Continue Reading
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26 Oct 2022
AHA: Metropolitan Anchor Hospitals Serve More Vulnerable Populations
The American Hospital Association’s new hospital designation, Metropolitan Anchor Hospitals, identifies facilities in urban markets that frequently provide care to Medicaid beneficiaries and other vulnerable populations. Continue Reading
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20 Oct 2022
85% of Facilities Are Facing Allied Healthcare Professional Shortages
Over half of healthcare facilities have increased pay rates and hired temporary staff to address allied healthcare professional shortages, a survey found. Continue Reading
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20 Oct 2022
KLAS Rates Provider Credentialing Solution Efficiency
The market research firm assesses 7 provider credentialing solutions to determine if they drive efficiency while delivering tangible outcomes. Continue Reading
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19 Oct 2022
Revenue Cycle Management Software Investments On The Rise
Providers are looking for software to address labor shortages, inflation, and other major challenges, and revenue cycle management solutions are at the top of their investment lists. Continue Reading
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18 Oct 2022
Hospitals Increase Recruitment Strategies Amid Workforce Shortages
The majority of hospital leaders reported raising starting salaries and introducing signing bonuses to improve recruitment as they manage persistent workforce shortages. Continue Reading
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18 Oct 2022
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
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14 Oct 2022
Healthcare Merger and Acquisition Revenues Totaled $8.3B in Q3 2022
Total healthcare merger and acquisition revenue for the third quarter of 2022 fell from quarter two’s $19.2 billion but was higher than the $5.2 billion generated in Q3 2021. Continue Reading
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12 Oct 2022
Practices Most Frustrated With Prior Auths, Then No Surprises Act
Regulatory burden is on the rise yet again as practices struggle with prior authorizations, No Surprises Act compliance, and the Quality Payment Program, MGMA reports. Continue Reading
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11 Oct 2022
Beaumont, Spectrum Merged Hospital System Rebrands to Corewell Health
The merged hospital system, newly named Corewell Health, aims to provide patients with simple, affordable, and equitable care. Continue Reading
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10 Oct 2022
Most Healthcare Consumers Do Not Research Pricing Options in Advance
More than half of healthcare consumers said they have never looked at pricing options for care but would consider shopping around if prices were disclosed ahead of time. Continue Reading
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06 Oct 2022
Analysis: COVID-19 Booster Campaign Could Save $44B in Healthcare Spending
In addition to healthcare spending reductions, Commonwealth Fund also reports that a COVID-19 booster vaccination campaign would also prevent over 75K deaths and 745K hospitalizations. Continue Reading
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04 Oct 2022
Hospital Margins Remained Negative in August Despite Revenue Increases
Hospital margins saw slight increases from July to August but remained negative, with the median operating margin at -0.3 percent. Continue Reading
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29 Sep 2022
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
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29 Sep 2022
Most Nonprofit Hospitals Updated Charity Care Policies During Pandemic
Among 127 hospitals that updated their charity care policies between 2019 and 2021, 47 made their policies more generous, while 12 implemented more restrictive policies. Continue Reading
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27 Sep 2022
Biden Administration Releases Data on Nursing Home Ownership
States, researchers, and consumers can access the new data, which provides nursing home ownership information for 15,000 nursing homes. Continue Reading
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26 Sep 2022
Inflation, Labor Costs Will Increase Healthcare Spending by $370B
Rising clinical labor costs will account for $170 billion of healthcare spending, and nonclinical labor costs will contribute $90 billion by 2027, researchers predicted. Continue Reading
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23 Sep 2022
Hospital Expenses Have Increased 23% in Less Than a Decade
Supply chain issues, medication costs, and labor challenges sparked by the COVID-19 pandemic have contributed to the spiking hospital expenses. Continue Reading
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22 Sep 2022
Physician-Led Hospitals Advance Care Quality, Market Competition
Metro areas with physician-led hospitals were more likely to have higher market competition and lower market concentration than areas with no physician-led facilities. Continue Reading
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22 Sep 2022
Healthcare Worker Unemployment, Clinician Burnout Rose During Pandemic
The unemployment rate for healthcare workers rose from 2.28 percent to 3.82 percent during the pandemic, while clinician burnout and emotional exhaustion increased from 31.8 percent to 40.4 percent. Continue Reading
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21 Sep 2022
US Rep. Urges HHS to Investigate Medicare Fraud Scheme by HCA
The alleged Medicare fraud scheme consisted of HCA Healthcare emergency rooms admitting patients for inpatient stays regardless of medical necessity and overcharging Medicare by $1.8 billion. Continue Reading
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21 Sep 2022
New Paper Claims Hospital Prices Are “Bleeding Americans Dry”
The paper from Families USA takes aim at hospital prices, accusing hospital corporations of putting profits over patients and exaggerating value-based payment progress. Continue Reading
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20 Sep 2022
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
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19 Sep 2022
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
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16 Sep 2022
Over Half of Hospitals to Have Negative Margins Through 2022
A new AHA report shows that hospitals are facing the most difficult year financially since the start of the pandemic as expenses and margins fail to hit pre-pandemic levels. Continue Reading
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15 Sep 2022
Automating Revenue Cycle Operations Can Reduce Cost-to-Collect
Health systems that used automation for revenue cycle operations had an average cost-to-collect of 3.51 percent compared to 3.74 percent for those that did not use automation. Continue Reading
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14 Sep 2022
Uninsured Rate Falling as Public Coverage Increases
The US Census Bureau reports that the percentage of people covered by some type of health insurance in 2021 was higher compared to 2020, with public coverage rising significantly. Continue Reading
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13 Sep 2022
Low Reimbursement, Staffing Shortages Lead to Rural Hospital Closures
An AHA report highlights the causes of rural hospital closures, which reached a record high of 19 closures in 2020 alone. Continue Reading
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12 Sep 2022
How Personalized Payment Plans Improve Patient Collections
Personalized, flexible payment plans in healthcare can empower patients to face their financial responsibility for care while ensuring providers collect what is owed to them. Continue Reading
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09 Sep 2022
Physician Practice Costs Grew 20% After Private Equity Acquisition
Following a private equity acquisition, physician practices saw a 20.2 percent increase in charges per claim, an 11 percent raise in the allowed amount per claim, and a 37.9 percent increase in new patient visits. Continue Reading
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07 Sep 2022
MGMA Calls for Prior Authorization Reform in Medicare Advantage
Prior authorization reform in Medicare Advantage would help relieve administrative burden for medical groups and reduce patient care delays, MGMA said. Continue Reading
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06 Sep 2022
FTC Urges States to Repeal COPA Laws, Prevent Illegal Hospital Mergers
Under COPAs, hospital mergers are subject to state oversight of healthcare prices and quality instead of antitrust enforcement from FTC, which can lead to anticompetitive markets. Continue Reading
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06 Sep 2022
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
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02 Sep 2022
Healthcare Executives Concerned About Supply Chain Issues, Cyberattacks
In addition to sharing their top business risks, healthcare executives said they plan to invest in IT, digital transformation, and cybersecurity and privacy in the next year. Continue Reading
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01 Sep 2022
Expanding Substance Use Disorder Coverage Would Cost Medicare $362M
If Medicare expanded substance use disorder coverage, the program would incur an additional $1.9 billion annually but save almost $1.6 billion from reduced spending on hospitalizations and medical conditions. Continue Reading
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31 Aug 2022
Home-Based Cardiac Care Led to Fewer Subsequent Hospitalizations
Just over 14 percent of patients who received home-based cardiac care experienced hospitalization in the following 12 months, compared to 18 percent of patients who received center-based care. Continue Reading
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29 Aug 2022
Hospital Finances Suffered as Margins, Revenue Declined in July
Hospital finances took a turn for the worse in July, with operating margins down 63 percent from June and gross operating revenue falling 3.6 percent. Continue Reading
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29 Aug 2022
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
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25 Aug 2022
When Cutting Healthcare Spending, MA Pulls Ahead of Medicare ACOs
Healthcare spending was significantly lower among Medicare Advantage (MA) patients compared Medicare ACO patients, suggesting a more difficult journey for health systems in MSSP. Continue Reading
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24 Aug 2022
AHA: High Hospital Costs Stem from Increased Patient Acuity
Higher patient acuity requires additional staff, more intensive treatments, and more expensive drugs, leading to higher hospital costs, AHA said. Continue Reading
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23 Aug 2022
With More Chronic Disease Comes More Medical Debt
A new study shows that the dollar amount of medical debt increases with the number of chronic diseases a patient has, which is leading to adverse financial outcomes. Continue Reading
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19 Aug 2022
CMS Offers Provider Resources for Public Health Emergency Ending
The agency released provider-specific fact sheets that detail which waivers and flexibilities will terminate once the COVID-19 public health emergency ends. Continue Reading
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19 Aug 2022
Locum Tenens Physicians Help Hospitals Address Staffing Shortages
Hospital administrators said that using locum tenens physicians helped boost patient access to care and address staffing shortages by filling vacant positions. Continue Reading
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17 Aug 2022
High Out-of-Pocket Costs Led to Low Patient Collection Rates
Self-pay after insurance patient collection rates dropped from 76 percent in 2020 to 55 percent in 2021 as the share of out-of-pocket balances over $7,500 grew. Continue Reading
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17 Aug 2022
COVID-19 Diagnosis Leads to More Healthcare Utilization Later
Elevated healthcare utilization could impact the ability of healthcare systems to maintain high-quality care during the ongoing pandemic, researchers said. Continue Reading
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16 Aug 2022
Cancer Centers Fail to Comply with Hospital Price Transparency Rule
Failing to post files in a machine-readable format was the most common violation of the hospital price transparency rule among NCI-designated cancer centers. Continue Reading
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15 Aug 2022
Out-of-Pocket Healthcare Spending Increased Leading Up to Pandemic
Between 2013 and 2019, out-of-pocket healthcare spending on outpatient services rose faster than spending on inpatient services, while prescription drug spending decreased. Continue Reading
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12 Aug 2022
Medical Billing Outsourcing Market to Grow at 16% CAGR
The COVID-19 pandemic spiked a surge in the use of digital billing, leading to significant growth in the medical billing outsourcing market. Continue Reading
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11 Aug 2022
Hospital Price Transparency Compliance Lags Nearly 20 Months Later
Hospital price transparency compliance is still very low even though hospitals have been subject to the new requirements for almost 20 months. Continue Reading
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10 Aug 2022
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
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08 Aug 2022
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
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03 Aug 2022
Hospitals, Physician Practices Saw High Expenses, Revenues in June
Total expenses for hospitals and physician practices were up 7 percent compared to June 2021, a Kaufman Hall report found. Continue Reading
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03 Aug 2022
Coding Drives Up Medical Billing Costs in the US
Another study confirms that medical billing costs in the US significantly exceed those in similar countries, but researchers now know why: coding drives up US administrative spending. Continue Reading
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02 Aug 2022
340B Hospitals Treated High Shares of Underserved Populations
In 2019, 340B hospitals were more likely than non-340B hospitals to treat underserved populations that benefit from increased access to quality care or incur high healthcare costs. Continue Reading
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29 Jul 2022
National Healthcare Spending Declines for First Time in 60 Years
The decline in national healthcare spending was mainly driven by the reduction in healthcare price growth relative to inflation, researchers said. Continue Reading
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27 Jul 2022
Nursing Home Staffing Challenges Worse During COVID-19 Outbreaks
Nursing home staffing challenges increased during severe COVID-19 outbreaks, with staffing hours 5.5 percent below pre-outbreak levels by the 16th week of an outbreak. Continue Reading
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25 Jul 2022
How Healthcare Spending, Utilization Varies by Payer, Region
In addition to healthcare spending varying significantly across Medicare, Medicaid, and private insurance plans, there was low correlation in spending within regions for each payer. Continue Reading
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21 Jul 2022
340B DSH Hospitals Provided $41B in Uncompensated Care in 2020
Operating margins for 340B DSH hospitals fell from -3.5 percent in 2019 to -6.1 percent in 2020, but the facilities still delivered $41.6 billion in uncompensated care. Continue Reading
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21 Jul 2022
Most Consumers Look to Payers for Healthcare Price Transparency
A survey shows that 60% of consumers who look for pricing information seek answers from their insurance companies, but healthcare price transparency should still be a priority for providers. Continue Reading
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20 Jul 2022
Minimum Staffing Requirements Could Cost Nursing Homes $10B Annually
More than 200,000 residents could be at risk of displacement if federal leaders establish minimum staffing requirements for nursing homes. Continue Reading
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20 Jul 2022
3 Areas That Will Impact Provider Profit Margins Post-COVID
A new report from McKinsey & Company shows that provider profit margins should increase after the COVID-19 pandemic based on three key shifts in payer mix and care delivery. Continue Reading
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19 Jul 2022
Physician Starting Salaries, Demand Rebounded from COVID-19 Lows
Physician starting salaries and the demand for specialty physicians have increased as individuals catch up on healthcare services they forwent during the pandemic’s peak. Continue Reading
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15 Jul 2022
Increase in Healthcare Spending Yielded Better Health Outcomes
Among most causes with the highest healthcare spending and highest burden, an increase in spending per case was associated with an increase in disability-adjusted life-years averted per case. Continue Reading
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14 Jul 2022
Pregnancy Care, Childbirth Led to $19K More in Healthcare Costs
Healthcare costs were 77 percent higher for pregnant women who had cesarean sections than those who had vaginal deliveries. Continue Reading
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14 Jul 2022
Healthcare Merger and Acquisition Activity Generates $19B in Q2 2022
An increase in healthcare merger and acquisition size contributed to higher revenue, with the average size of the smaller party hitting $1.5 billion. Continue Reading
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13 Jul 2022
22% of Revenue Cycle Leaders Outsource Outpatient RCM Services
Among revenue cycle leaders who outsource outpatient RCM services, anesthesiology, gastroenterology, and urology were the most common services. Continue Reading
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12 Jul 2022
How Hospital Affiliation Impacts Risk of Closure for Rural Hospitals
Hospital affiliation was generally not associated with a lower risk of closure for rural hospitals except when the hospitals were financially unstable. Continue Reading
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11 Jul 2022
How Health Systems Can Improve Patient Collections
Open communication, payment options, and understanding are all key to improving patient collections in a consumer-oriented healthcare landscape. Continue Reading
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07 Jul 2022
Healthcare Revenue Falling Short of 2022 Goals for Many Providers
Nearly half of CFOs and revenue cycle VPs in a recent survey said their organizations are behind their 2022 healthcare revenue goals. Continue Reading
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05 Jul 2022
Provider Compensation, Productivity Increased to Pre-Pandemic Levels
As provider compensation and productivity increased, compensation per wRVU fell significantly due to service volumes recovering to pre-pandemic levels. Continue Reading
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30 Jun 2022
Rising Expenses Continue to Hurt Health System, Hospital Finances
Inflation and labor shortages contributed to rising expenses in May, continuing the trend of poor hospital finances in 2022. Continue Reading
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29 Jun 2022
Hospital Price Transparency Higher in Less Competitive Markets
Hospitals with more beds and for-profit hospitals were also more likely to comply with the price transparency rule, the study found. Continue Reading
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29 Jun 2022
Health Inequity Leads to $320B in Unnecessary Healthcare Spending
Stakeholders can help curb high healthcare spending by addressing health inequities, such as socioeconomic, racial, and gender disparities. Continue Reading
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27 Jun 2022
AHA Shares Strategies for Addressing Healthcare Workforce Challenges
Fostering a culture where employees feel safe and ensuring access to behavioral healthcare services can help hospitals and health systems address healthcare workforce challenges, AHA said. Continue Reading
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23 Jun 2022
Cerner Patient Accounting Software Receives Mixed Reviews
Customers using Cerner’s patient accounting software, Soarian Financials, reported issues with the implementation, training resources, and high costs, a KLAS report found. Continue Reading
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23 Jun 2022
Private Capital Investments May Help Sustain Skilled Nursing Facilities
Federal and state governments cannot support skilled nursing facilities alone, requiring the need for private capital investments to further innovation. Continue Reading
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21 Jun 2022
Two Healthcare Mergers Abandoned Following Pushback from FTC
The healthcare mergers between RWJBarnabas Health and Saint Peter’s Healthcare System and HCA Healthcare and Steward Health Care System will not proceed after FTC filed complaints against them. Continue Reading
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20 Jun 2022
Medical Debt Plagues 41% of Americans, KFF Survey Finds
Medical debt was more common among Americans with low income and education, women, and Black and Hispanic adults. Continue Reading
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17 Jun 2022
ChristianaCare Signs Merger Agreement to Acquire Jennersville Hospital
The merger agreement will allow ChristianaCare to transform the previously closed Jennersville Hospital into a new healthcare campus to serve the community. Continue Reading
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16 Jun 2022
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
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15 Jun 2022
Clinical Waste Accounts for Up to 15% of All Healthcare Spending
Identifying and reducing clinical waste are necessary steps to curb healthcare spending growth, researchers said. Continue Reading
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13 Jun 2022
AHA Supports Bill to Increase Oversight of Travel Nursing Agencies
The bill calls for increased oversight from GAO on travel nursing agencies and certain business practices such as price gouging. Continue Reading
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10 Jun 2022
Newly Hired Nurses Working Most Shifts as Staffing Shortages Persist
As more experienced nurses leave the workforce and staffing shortages worsen, newly hired nurses are picking up more shifts. Continue Reading
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10 Jun 2022
Nonprofit Hospitals Offered $110B in Community Benefits in 2019
Community benefits exceeded federal tax exemptions for nonprofit hospitals in 2019, as hospitals forwent $12.4 billion in tax revenue and directed $110 billion toward their communities. Continue Reading
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09 Jun 2022
Georgia Hospitals Fined for Hospital Price Transparency Violations
The hospitals failed to comply with the machine-readable file and shoppable services requirements of the hospital price transparency rule. Continue Reading
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09 Jun 2022
Most Hospitals Lack Effective Cost Reduction Programs, Survey Finds
Hospitals must identify areas for savings, establish a governance structure, and foster collaboration to achieve effective cost reduction programs, researchers said. Continue Reading
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08 Jun 2022
200K to 450K Nursing Shortage Expected by 2025 Without Action
Low projected rates of new nurses along with increased patient demand related to COVID-19 and an aging population are expected to exacerbate the nursing shortage by 2025. Continue Reading
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08 Jun 2022
AMGA Asks CMS to Amend Good Faith Estimate Policy, Guidance
The good faith estimate policy creates substantial administrative burden for healthcare practices, which could negatively impact patient care, AMGA said. Continue Reading
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07 Jun 2022
88% of Healthcare Facilities Employed Locum Tenens Providers
Locum tenens providers, also known as temporary providers, helped healthcare facilities treat high volumes of COVID-19 patients and address clinician burnout in 2021 and 2022. Continue Reading
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07 Jun 2022
Hospitals, Health Systems Added 16.3K New Jobs in May 2022
Hospitals and health systems, physician offices, and nursing care facilities saw employment growth in May 2022, while health practitioner offices saw decreases. Continue Reading
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06 Jun 2022
OR Healthcare Workers Seek Union Representation to Boost Provider Agency
Around 300 St. Charles Medical Group healthcare workers are seeking union representation to increase provider input in managerial decision-making. Continue Reading
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06 Jun 2022
TN Court Develops Platform for Negotiating Medical Debt Challenges
Tennessee residents can use the platform to communicate with hospital representatives and mediators to work out their medical debt challenges outside of the courtroom. Continue Reading
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02 Jun 2022
Low Revenue, Patient Volumes Led Hospital Finances to Regress
Hospital finances are hurting once again as health systems saw negative operating margins, low revenues, and declining patient volumes in April. Continue Reading