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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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
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01 Jun 2022
High Registered Nurse Staffing Levels Tied to Lower Mortality Rates
An increase in nurse hours per patient day was associated with a 3 percent decrease in the odds of sepsis-related mortality rates, highlighting the importance of adequate registered nurse staffing levels. Continue Reading
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01 Jun 2022
Top-Ranked Hospitals Not Complying with Price Transparency Rule
Only 35 percent of the top 20 hospitals reported cash, minimum, and maximum negotiated prices for six common shoppable services, indicating low compliance with the hospital price transparency rule. Continue Reading
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31 May 2022
COVID-19 Pandemic Did Not Impact Medical Debt Among Americans
Despite causing job and insurance losses, the COVID-19 pandemic did not negatively impact medical debt, likely due to temporary premium subsidies and a decline in elective healthcare. Continue Reading
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31 May 2022
Physician Compensation on the Rise, Marking Post-Pandemic Recovery
Physician compensation and productivity is showing signs of post-pandemic recovery in 2021, as rates surpass or reach pre-pandemic levels. Continue Reading
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26 May 2022
AHA Calls for Oversight of Pharmacy Benefit Manager Practices
Pharmacy benefit manager practices create more unnecessary responsibilities for hospitals and providers and can threaten patient safety, AHA said. Continue Reading
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26 May 2022
Advocate Aurora Health Faces Allegations of Anticompetitive Practices
Anticompetitive practices such as “all-or-nothing” contracts and excessive merger activity have caused Wisconsin employers to pay higher healthcare prices. Continue Reading
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25 May 2022
Lack of Prior Authorization Reform Escalating Physician Burden
Prior authorization reform is lagging, with most physicians reporting that the number of medical services requiring prior authorization has increased in the last five years. Continue Reading
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25 May 2022
US Surgeon General Offers Steps to Address Healthcare Worker Burnout
The Surgeon General’s advisory recommended that employers improve access to mental healthcare services and reduce administrative burden to address healthcare worker burnout. Continue Reading
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24 May 2022
MGMA Requests Updates to Independent Dispute Resolution Portal
The organization recommended CMS update the independent dispute resolution portal to improve communication between disputing parties and adjust the form field requirements. Continue Reading
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23 May 2022
Healthcare Finance Leaders Facing Revenue Cycle Workforce Shortages
More than 400 healthcare finance leaders reported having revenue cycle workforce shortages, with almost 20 percent seeing 30 or more vacancies. Continue Reading
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20 May 2022
CO Supreme Court: Hospital Cannot Enforce $229K Surprise Bill
The surprise bill stemmed from the hospital’s chargemaster rate, but the hospital did not provide this information to the patient before her surgery. Continue Reading
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19 May 2022
COVID-19 Federal Relief Funds Helped Offset Hospital Financial Losses
COVID-19 federal relief funds helped neutralize hospital financial losses in 2020, with government, rural, and smaller hospitals seeing higher profit margins than in 2019. Continue Reading
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18 May 2022
COVID-19 Vaccine Mandate Boosted Nursing Home Staff Vaccination Rates
The vaccination rate among nursing home staff rose from 63 percent to 88 percent between the introduction of the COVID-19 vaccine mandate in August 2021 and the compliance deadlines in March 2022. Continue Reading
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18 May 2022
Hospitals Performed 100K Low-Value Procedures During Pandemic
Coronary stents were the most common low-value procedure patients received in 2020, which can increase the risk of stroke, heart attack, and infection. Continue Reading
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17 May 2022
New Internists Are Choosing Hospitals Over Outpatient Settings
The primary care physician shortage may worsen as new internists practice in hospital settings and more senior physicians in outpatient settings near retirement. Continue Reading
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16 May 2022
AHA Requests Funding Increase to Support Pediatric Workforce
AHA and fellow healthcare organizations have urged Congress to support the pediatric workforce and provide $718.8 million in CHGME funding for FY 2023. Continue Reading
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16 May 2022
Choosing the Right Partner to Streamline Revenue Cycle Management
With the healthcare system transitioning to value-based care, its ability to leverage partnerships for revenue cycle management that promote efficiency... Continue Reading
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13 May 2022
Advocate Aurora Health, Atrium Health to Create Joint Health System
The joint health system will leverage data analytics and digital consumer infrastructure capabilities to improve care for 5.5 million patients. Continue Reading
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13 May 2022
Assessing Progress on the Hospital Price Transparency Rule
More than a year after the regulation went into effect, compliance with the hospital price transparency rule remains low, as hospitals are hesitant to invest in necessary software and resources. Continue Reading
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12 May 2022
Rising Contract Labor Utilization Boosted Hospital Labor Expenses
As hospitals faced workforce shortages, contract labor utilization and expenses in March 2022 were five times higher than pre-pandemic levels. Continue Reading
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11 May 2022
Fewer Adults Faced Medical Debt Challenges During Pandemic
The share of adults facing medical debt challenges such as problems paying medical bills and debt in collections fell in 2021, but variation among different ages and races persisted. Continue Reading
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11 May 2022
Nurse Workforce Shortage Looms as More Nurses May Leave Profession
The share of nurses considering leaving the profession increased from 11 percent in 2020 to 29 percent in 2021, raising concerns about the ongoing nurse workforce shortage. Continue Reading
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10 May 2022
Ambulatory Care, Hospital Employment Grew During April 2022
Hospital employment increased by 4,500 jobs last month but is still down 100,000 jobs compared to before the COVID-19 pandemic. Continue Reading
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09 May 2022
Cerner Partnership Leverages AI for Revenue Cycle Automation
Cerner customers will gain access to a revenue cycle automation platform to automate eligibility checks and denials, authorization tasks, and claims processing. Continue Reading
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06 May 2022
How Healthcare Mergers, Acquisitions Impact Practice Management
With an abundance of differing data, the industry remains divided on how healthcare mergers and acquisitions impact practice management, such as healthcare costs and patient quality of care. Continue Reading
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05 May 2022
COVID-19 Pandemic Exacerbated Healthcare Workforce Challenges
Between March and April 2020, the healthcare industry lost 1.5 million workers, exacerbating healthcare workforce challenges and staffing shortages. Continue Reading
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05 May 2022
Rural Hospitals Facing Risk of Closure Due to Financial Stress
Negative operating margins, negative net assets, and workforce challenges are putting rural hospitals at risk of closure. Continue Reading
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04 May 2022
Vertical Integration, Joint Contracting Increased Physician Prices
Vertical integration and joint contracting with large health systems increased primary care physician prices by 12 percent and specialist prices by 6 percent. Continue Reading
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03 May 2022
Private Equity Acquisitions Did Not Impact Hospital Quality, Spending
While patients with acute myocardial infarction saw decreased mortality rates, private equity acquisitions did not significantly impact care quality or spending at short-term acute care hospitals. Continue Reading
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03 May 2022
Outpatient Volumes Led to Better Physician, Hospital Revenues in March
Hospitals saw rising outpatient volumes, physician groups had higher compensations, and both sectors experienced revenue increases last month following the end of the Omicron surge. Continue Reading
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02 May 2022
Catholic Orgs Agree to Merge, Form Integrated Healthcare Network
SSM Health plans to acquire SLUCare Physician Group and create an integrated healthcare network consisting of more than 1,200 providers. Continue Reading
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27 Apr 2022
Financial Losses, Challenges Persist for Hospitals, Health Systems
More than a third of hospitals are operating on negative margins as the COVID-19 pandemic continues to generate financial losses and challenges for health systems. Continue Reading
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26 Apr 2022
Medical Debt Challenges Common Among Consumer Complaints
Consumer complaints revealed that individuals often paid off invalid medical debt to improve their credit scores or to stop debt collectors from contacting them, among other medical debt challenges. Continue Reading
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25 Apr 2022
Trinity Health to Acquire MercyOne, Streamline Healthcare Access
After jointly operating the health system with CommonSpirit Health, Trinity Health plans to acquire all MercyOne facilities and integrate its strategies and services to streamline healthcare access for patients. Continue Reading
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22 Apr 2022
Physician Practice Acquisitions By Hospitals, Corporations Grew
More physicians left independent practices and became employed by hospitals and corporate entities as physician practice acquisitions increased during the pandemic. Continue Reading
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22 Apr 2022
Revenue Cycle Leaders Experience Price Transparency Rule Burden
Revenue cycle leaders noted that the confusing regulations included in the CMS price transparency rule make it difficult for their organizations to achieve compliance. Continue Reading
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21 Apr 2022
Large Hospitals with Low Profits Saw More Ownership Changes
CMS data also revealed that ownership changes were more common among long-term care hospitals and urban hospitals. Continue Reading
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19 Apr 2022
Physician Compensation Varied by Gender, Race Despite Overall Raises
White physicians earned more than $345,000 in 2021, but physician compensation for Black, Hispanic, and Asian physicians remained lower than $330,000. Continue Reading
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18 Apr 2022
New Jersey Health Systems Terminate Hospital Merger Agreement
Hackensack Meridian Health and Englewood Health submitted a motion to dismiss the Federal Trade Commission’s complaint and announced the end of their hospital merger agreement. Continue Reading
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18 Apr 2022
RPA and ROI: Making the Business Case for Healthcare Automation
Truly measuring the success of RPA adoption requires a wide set of revenue cycle management metrics. Continue Reading
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15 Apr 2022
Community Health Centers Faced Hefty Workforce, Nursing Shortages
Community health centers agreed that additional federal funding would help alleviate workforce and nursing shortages and address the factors driving staff departure. Continue Reading
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12 Apr 2022
Nonprofit Hospitals Saw High Tax Breaks, Low Charity Care Spending
The ten nonprofit hospitals with the highest tax breaks and lowest charity care investments accounted for 30 percent of the total fair share deficit in 2019. Continue Reading
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12 Apr 2022
Nonprofit Patient Revenue, Operating Expenses Rose Amid Delta Surge
In addition to rising patient revenue and operating expenses during the 2021 Delta surge, nonprofit hospitals saw increases in discharges, patient days, and surgery volumes. Continue Reading
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11 Apr 2022
Long-Term Care Workers Saw Continuously High Turnover Rates in 2021
Long-term care workers, women with young children, and racial minorities were more likely to see high healthcare turnover rates during the COVID-19 pandemic. Continue Reading
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11 Apr 2022
AHA Asks Congress Again for More COVID-19 Financial Relief
AHA voiced its disappointment that Congress is adjourning for its April recess without providing additional COVID-19 financial relief to hospitals, including more Provider Relief Funds and Medicare sequester respite. Continue Reading
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08 Apr 2022
Healthcare Merger and Acquisition Activity Hit Record Low in Q1 2022
While healthcare merger and acquisition activity reached an all-time low, the number of transactions involving a for-profit seller hit a record high of 58 percent. Continue Reading
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08 Apr 2022
Top RCM Vendors for Revenue Integrity, Underpayment Services
Revenue cycle management vendor Aspirion received the highest overall performance score for revenue integrity and underpayment services, while vendors like TransUnion Healthcare saw low ratings all around. Continue Reading
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07 Apr 2022
Intermountain Healthcare, SCL Health Finalize Healthcare Merger
After receiving approval from the Colorado Department of Law for their healthcare merger, Intermountain Healthcare and SCL Health will form one nonprofit health system, serving patients across seven states. Continue Reading
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06 Apr 2022
Hospital, Health System Employment Grew by 5,100 in March 2022
While hospital and health system employment grew last month, nursing and residential care facilities continued to face staffing shortages and lost 4,000 jobs. Continue Reading
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05 Apr 2022
Private Equity Acquisitions Improved Hospital Financial Performance
After experiencing private equity acquisitions, hospital costs per adjusted discharge fell by $432 while operating margins increased by 1.78 percentage points. Continue Reading
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30 Mar 2022
Hospital Operating Margins Still Negative After Omicron Surge
Hospital operating margins have remained negative for the second consecutive month, with health systems still seeing revenue and patient volume declines following the Omicron surge. Continue Reading
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28 Mar 2022
Consumers Faced Surprise Medical Bills, Payment Struggles in 2021
Better price transparency from providers and a focus on automated payment processes may help consumers avoid surprise medical bills and other financial challenges. Continue Reading
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28 Mar 2022
What to Know When Selecting the Right Automation Partner
Healthcare organizations will need to determine whether they build and manage robotic process automation themselves or require assistance from a strategic partner and expert in the field. Continue Reading
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24 Mar 2022
AHA Requests Additional COVID-19 Financial Support from Congress
During the Delta and Omicron surges, hospitals and health systems faced significant challenges, prompting AHA to ask Congress for additional COVID-19 financial support. Continue Reading
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23 Mar 2022
Mass Hospitals Offered Low Charity Care Despite High 340B Revenue
Hospitals are supposed to direct 340B revenue and savings toward healthcare services for low-income and uninsured patients, but Massachusetts health systems saw low levels of charity care in 2020. Continue Reading
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21 Mar 2022
70% of Medical Collection Debt Will Leave Consumer Credit Reports
Equifax, Experian, and TransUnion will adjust their medical collection debt reporting to reduce the amount of debt displayed on consumer credit reports. Continue Reading
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18 Mar 2022
New Revenue Cycle Management Offerings Introduced at HIMSS22
Healthcare vendors announced new solutions at HIMSS22, including end-to-end revenue cycle management platforms and tools to improve patient billing processes. Continue Reading
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18 Mar 2022
Revenue Cycle Management Leaders Need Registrars, Billing Specialists
As healthcare finance leaders struggle to fill revenue cycle management positions, automation may help solve staffing shortages and heavy workloads. Continue Reading
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17 Mar 2022
Burnout, Stress Fuel Nurse Staffing Shortage, Turnover Rates
Burnout and stressful environments may exacerbate the nurse staffing shortage, as more than 30 percent of nurses plan to leave their current position by the end of the year. Continue Reading
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16 Mar 2022
Poor Compensation Spurred Pharmacy Technician Staffing Shortages in 2021
Pharmacy administrators have offered base pay increases to help improve retention as hospitals face pharmacy technician staffing shortages due to poor compensation. Continue Reading
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16 Mar 2022
Healthcare Tech Company Launches Online Price Transparency Tool
Through the online price transparency tool, users can view hospital service prices and assess machine-readable file completeness. Continue Reading
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15 Mar 2022
Daily Variation in Nursing Home Staffing Led to Poorer Clinical Quality
Nursing homes with high daily variation in staffing were less likely to meet the quality measures included in the Nursing Home Care Compare report. Continue Reading
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15 Mar 2022
Sutter Health Receives Jury Support in Antitrust Class Action
In a recent antitrust class action lawsuit, a Northern California jury rejected claims that Sutter Health used anticompetitive actions to increase premiums for patients and payers. Continue Reading
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14 Mar 2022
Medical Liability Insurance Premiums Continued to Increase in 2021
Since 2019, around 30 percent of medical liability insurance premiums have increased every year, with 12 states seeing premium increases of 10 percent or more in 2021. Continue Reading
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11 Mar 2022
WEDI Voices Concerns About Good Faith Estimates Implementation
The good faith estimates policy creates excessive administrative burden for providers and can lead to bill discrepancies and confusion for patients, WEDI said. Continue Reading
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09 Mar 2022
How Nonprofit Hospitals, Health Systems Compensate Executives
Nonprofit health systems that made between $3.1 billion and $5.5 billion in 2019 used an average of 0.64 percent of that revenue to compensate their executives. Continue Reading
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09 Mar 2022
AHA: Good Faith Estimates Create Administrative Burden for Hospitals
AHA urged CMS to adjust the patient-provider dispute resolution process and align price transparency policies to relieve the administrative burden resulting from the good faith estimates regulation. Continue Reading
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08 Mar 2022
AMA Framework to Help Orgs Invest in, Advance Health Equity
The AMA initiative will help healthcare stakeholders invest in programs and solutions that advance health equity and prioritize marginalized communities. Continue Reading
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08 Mar 2022
Northwell Health to Use AI, NLP to Improve Revenue Cycle Management
Through a deal with an artificial intelligence company, the health system will leverage natural language processing to automate its revenue cycle management. Continue Reading
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07 Mar 2022
PCP Turnover, Burnout Generated $979M in Excess Healthcare Spending
With an estimated 11,339 primary care physicians leaving their practice each year, physician turnover generated over $900 million in excess healthcare spending. Continue Reading
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07 Mar 2022
Using Intelligent Automation to Improve Healthcare Operations
By collaborating with a strategic technology partner, healthcare organizations can improve revenue cycle management and day-to-day business operations with... Continue Reading
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04 Mar 2022
Credit Reports Showed $88B in Past-Due Medical Debts in 2021
When past-due medical bills appear on consumer credit reports, individuals may face difficulties finding jobs, securing housing, and accessing additional healthcare services. Continue Reading
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04 Mar 2022
Tenet Healthcare Drops Revenue Cycle Management Subsidiary Spinoff
Tenet Healthcare will not spin off its revenue cycle management subsidiary, Conifer Health Solutions, following financial improvements and positive expectations. Continue Reading
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03 Mar 2022
Lower-Income, Younger Americans Faced More Medical Debt Struggles
Medical debt impacted credit scores and spending habits for Generation Z and Millennials, while lower-income Americans had more experience with debt collectors than their more affluent counterparts. Continue Reading
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01 Mar 2022
Hospital Revenue Fell as Expenses Increased Amid Omicron Surge
Hospitals delayed nonurgent care during the Omicron surge in January, which led to declines in revenue and increased expenses. Continue Reading
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28 Feb 2022
AHA Asks CMS to Amend Residency Slot Distribution in IPPS Final Rule
AHA urged CMS to prioritize hospitals that meet all qualifying categories instead of just hospitals in health professional shortage areas when distributing residency slots. Continue Reading
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23 Feb 2022
50% of Hospitals Meet Price Transparency Rule for Lumbar Spine MRI
Lumbar spine MRI is considered a shoppable service under the CMS hospital price transparency rule, but only half of the hospitals that offer the service published prices for it. Continue Reading
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22 Feb 2022
RI Attorney General Rejects Lifespan, Care New England Merger
The Attorney General said the healthcare merger could cause reduced market competition, higher healthcare costs, and poorer healthcare quality. Continue Reading
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21 Feb 2022
AHA Urges Congress to Address Behavioral Healthcare Provider Shortage
Increasing the number of physician residency slots and strengthening loan forgiveness programs could help address the behavioral healthcare provider shortage and boost access to care, AHA said. Continue Reading
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21 Feb 2022
High-Impact Robotic Process Automation Use Cases for the Revenue Cycle
Robotic process automation can create efficiencies across the many phases of revenue cycle management and contribute to improving the patient experience. Continue Reading
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17 Feb 2022
Top 5 Best Overall Nurse Staffing Agencies
Nurse staffing agencies that experienced growth and positive reviews during 2021 include Triage Staffing, Host Healthcare, and Fusion Medical Staffing. Continue Reading
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17 Feb 2022
Healthcare CFOs Plan to Invest in Patients, Partnerships in 2022
Healthcare CFOs plan to maintain positive performances in 2022 by investing in strategies that prioritize patient experience, partnerships, and health equity. Continue Reading
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16 Feb 2022
Hartford HealthCare Faces Antitrust Lawsuit, Monopoly Allegations
The healthcare antitrust lawsuit alleges that the health system has created a monopoly on inpatient hospital care through anticompetitive actions. Continue Reading
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14 Feb 2022
Only 14% of Hospitals Met Price Transparency Rule Compliance
One year after the hospital price transparency rule went into effect, 85 percent of hospitals are still not complying with the federal requirements to publicly post prices for services. Continue Reading
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14 Feb 2022
What Is Healthcare Revenue Cycle Management?
As the industry continues to transition from fee-for-service to value-based care reimbursement, healthcare revenue cycle management must adapt accordingly. Continue Reading
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11 Feb 2022
AMA: Prior Authorization Creates Physician Burden, Patient Care Delays
Although health plans aim to promote value-based care with prior authorization requirements, providers and patients may experience negative repercussions from the process. Continue Reading
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09 Feb 2022
Provider Collaboration Needed to Drive Patient Experience, ACO Success
By collaborating with providers across a patient’s continuum of care, ACOS can improve the patient experience. Continue Reading
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09 Feb 2022
Who Are the Top Revenue Cycle Management Vendors of This Year?
KLAS has unveiled its picks for the best revenue cycle management vendors going into 2022, including top chargemaster maintenance, patient accounting, and RPA companies. Continue Reading
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07 Feb 2022
Hospital Labor Shortages Debuts as Top Concern for CEOs in 2021
Hospital labor shortages, including nurse and technician shortages, were the top concern for CEOs last year, a spot that was previously held by financial challenges every year since 2004. Continue Reading
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02 Feb 2022
Higher Patient Volumes, Physician Productivity Aid Revenue Growth
Physician practices experienced strong recovery in 2021 with rises in patient volume, physician productivity, and revenue growth. However, physician expenses climbed, surpassing 2020 performance. Continue Reading
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31 Jan 2022
Hospital Finances Still Recovering as We Enter Third Year of Pandemic
Hospitals ended 2021 in a better financial position compared to 2020, but they are entering the third year of the pandemic with higher expenses and labor shortages. Continue Reading
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31 Jan 2022
Healthcare Orgs Hit Revenue Cycle Talent Recruitment Snags
Finding senior-level revenue cycle talent is the most challenging for healthcare organizations, but even entry-level roles take an average of 84 days to fill. Continue Reading
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27 Jan 2022
White House Urged to Look into Price Gouging by Nurse Staffing Agencies
Members of Congress want the White House to investigate nurse staffing agencies after receiving reports of price gouging. Continue Reading
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26 Jan 2022
Ambulatory Care Employment Surpasses Pre-Pandemic Rates
A report shows that overall healthcare employment remains below pre-pandemic rates. However, ambulatory care employment rates have fully recovered. Continue Reading
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25 Jan 2022
Healthcare Workforce Set to Face High Resignation Rates Within 2 Years
A study found that the healthcare workforce could dwindle in the face of increased burnout, workload, and COVID-19-associated stress. Continue Reading
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24 Jan 2022
Where Hospital Price Transparency Compliance Is Lagging
A study found hospital price transparency compliance to be slower for machine-readable files than for shoppable service requirements. Continue Reading
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19 Jan 2022
Investor-Owned Health Systems Linked to Most Low-Value Care
Higher amounts of overuse among health systems were associated with investor ownership and the number of primary care physicians. Continue Reading
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13 Jan 2022
Large Hospital Mergers Signal New Phase of Healthcare Deals
2021 did not set any records for the number of hospital mergers and acquisitions, but data shows a shift to larger deals between well-established organizations. Continue Reading