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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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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27 Jul 2021
Medicaid Expansion Associated with Less Medical Debt Collections
States that expanded Medicaid in 2014 experienced a 45% decline in the mean flow of medical debt collections by 2020 compared to states that didn’t expand Medicaid. Continue Reading
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26 Jul 2021
Hospital Staffing Shortages a Concern with Mandatory Vaccinations
Many hospitals—with the AHA’s support—are requiring COVID-19 vaccinations among healthcare personnel, but some leaders fear the policies could worsen hospital staffing shortages. Continue Reading
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26 Jul 2021
Primary Care Spending Very Low for Veterans Health Administration
Even as its total spending increased, Veterans Health Administration primary care spending went down between 2014 and 2018. Continue Reading
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26 Jul 2021
Will COVID-19 Have a Lasting Effect on RCM Workflows?
Some practices are re-thinking their RCM workflows and suppliers after COVID-19 exposed challenges with system integrations and operational requirements. Continue Reading
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21 Jul 2021
94% of Hospitals Noncompliant with Hospital Price Transparency Rule
Just over six months after the hospital price transparency rule went into effect, only 5.6% of hospitals are compliant, new research shows. Continue Reading
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21 Jul 2021
How Providers Pick a Healthcare Enterprise Resource Planning System
A KLAS report finds that organizations look for functionality, full-suite integration, and cloud technology when selecting a healthcare enterprise resource planning system. Continue Reading
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19 Jul 2021
RCM Vendors Scooping Up Patient Payment Companies
Waystar announced that it plans to acquire Patientco in the latest deal of several deals between an RCM vendor and a patient payment company. Continue Reading
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15 Jul 2021
Revenue Cycle KPIs Are Evolving as Automation Takes Hold
Leaders identified the number of days a claim sits in accounts receivable, the number of past due patient bills, and initial denials rates as top revenue cycle KPIs. Continue Reading
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14 Jul 2021
Study Raises Concerns About Gender Pay Gap in Healthcare
Researchers observed a pronounced gender pay gap in healthcare after studying salary disparities among internal medicine specialties in medical schools. Continue Reading
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13 Jul 2021
Nurse Understaffing Impacts Patient Safety, Practice Management
Nurse understaffing during the COVID-19 pandemic may have led to practice management workarounds that negatively impacted personnel and patient safety. Continue Reading
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12 Jul 2021
Nonprofit Hospitals Fail to Fulfill Community Health Investments
The Lown Institute Hospitals Index reveals that 72 percent of private nonprofit hospitals spent less on community health investments than they received in tax breaks. Continue Reading
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12 Jul 2021
Despite Drop in Healthcare Mergers and Acquisitions, Revenue Rises
Analysis from Kaufman Hall reveals a historically low number of healthcare mergers and acquisitions in Q2, but revenue continues to rise. Continue Reading
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09 Jul 2021
1 in 5 Childbirths Lead to Surprise Billing, Study Shows
As implementation of the No Surprises Act begins, a new study analyzes the prevalence of surprise billing for childbirth and newborn hospitalizations in the US. Continue Reading
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08 Jul 2021
Healthcare Mergers and Acquisitions Linked to Physician Burnout
Healthcare mergers and acquisitions and other organizational changes including staff layoffs and EHR implementation are leading causes of physician burnout, a recent survey reveals. Continue Reading
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08 Jul 2021
3 Strategies for Revenue Cycle Management Optimization
Revenue cycle management optimization will be key to recovering from last year’s devastating losses. Here are 3 strategies from leading provider organizations. Continue Reading
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07 Jul 2021
New OSHA Standard to Disrupt Healthcare Workforce Management
MGMA is calling for the DOL to rescind or delay its COVID-19 healthcare emergency temporary standard, which may cause disruptions in healthcare workforce management. Continue Reading
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01 Jul 2021
Healthcare Turnover Rate Dips Again for Hospital CEOs
The healthcare turnover rate for hospital CEOs decreased again to 16% in 2020, signaling a need for strong leadership teams during the pandemic. Continue Reading
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30 Jun 2021
Hospital Price Transparency Rule Awareness Low Among Consumers
HHS’ hospital price transparency rule was designed to enable consumers to shop for healthcare but few adults even know hospitals need to disclose prices. Continue Reading
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29 Jun 2021
Physician Practice Acquisitions Accelerated During COVID-19
A new study shows an acceleration of physician practice acquisitions, leading to nearly half of US physician practices being owned by hospitals and corporations. Continue Reading
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28 Jun 2021
Hospital Financial Performance Shows Signs of Post-COVID Recovery
Hospital financial performance is improving, with hospital volumes, revenues, and margins increasing in May after months of dramatic losses. Continue Reading
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23 Jun 2021
Physician Work Hours Significantly Declined Since Start of COVID-19
Shifts in healthcare utilization and care delivery likely cause a decline in physician work hours during the pandemic, but average hours worked are still lower than pre-pandemic, a study shows. Continue Reading
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22 Jun 2021
LifePoint Health Announces Plans to Acquire Kindred Healthcare
As part of the health system merger deal, LifePoint would also invest $1.5B over the next three years to advance care delivery in the communities it serves. Continue Reading
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22 Jun 2021
Fixed-Rate Hospital Contracts Are Associated with Lower Costs
When looking at hospital-insurer contracts, researchers found that fixed-rate contracts correlate with lower costs and prices compared to discounted charges contracts. Continue Reading
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21 Jun 2021
Rural Counties in Missouri See Higher Rates of Nursing Shortages
The state’s rural counties have greater rates of nursing shortages and have more nurses nearing the age of retirement, emphasizing the need to improve recruitment methods. Continue Reading
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21 Jun 2021
Large Hospitals Using Price Estimator Tools for Price Transparency Rule
Out of the 100 top-grossing hospitals, 86 use a price estimator tool but overall compliance with the new price transparency rule is still low. Continue Reading
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18 Jun 2021
Beaumont Health, Spectrum Health Announce Merger Plans
Merging the two health systems would create the largest system in Michigan, operating 22 hospitals and 305 outpatient centers, as well as a health plan. Continue Reading
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16 Jun 2021
Staff Shadowing Negatively Affects Revenue Cycle Productivity
A new survey shows that staff shadowing preceding automation integration is disruptive to employees and has negative impacts on revenue cycle productivity. Continue Reading
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16 Jun 2021
Report Grades Hospitals on Predatory Patient Billing Practices
The report from JHU and Axios grades hospitals based on predatory patient billing practices, like suing patients over unpaid bills, or lack thereof. Continue Reading
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15 Jun 2021
12 Health Systems Shop Local to Boost Supply Chain Sustainability
The health systems signed a commitment to improve supply chain sustainability and support local businesses, especially those owned by minorities and women. Continue Reading
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15 Jun 2021
COVID-19 Elevated Consumerism, How University Hospitals Is Responding
A revenue cycle leader at University Hospitals shares the keys to success with healthcare consumerism and improving the patient financial experience. Continue Reading
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14 Jun 2021
AAMC Predicts 37K to 124K Physician Shortage by 2034
Population growth and aging are driving the physician shortage, with older physicians leaving the workforce and older Americans requiring more care. Continue Reading
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10 Jun 2021
Report Identifies Markets Ripe for Payvider Adoption, Growth
Cities like Miami, Phoenix, and Tampa have the highest value-based growth potential, making them ripe for payviders adoption, a new analysis shows. Continue Reading
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10 Jun 2021
Revenue Cycle Outsourcing Solves Staffing Challenges for AZ Practice
When Tucson Gastroenterology faced an onslaught of staffing changes, revenue cycle outsourcing helped to fill the gaps and improve efficiencies in the process. Continue Reading
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09 Jun 2021
How Providers Can Improve Patient Financial Experience
In the aftermath of COVID-19, payment flexibility, digital engagement, and transparency are crucial to improving patient financial experience, recent reports show. Continue Reading
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08 Jun 2021
One Medical Will Expand Care With Acquisition of Iora Health
The primary care provider One Medical will work to expand its care services as a result of acquiring fellow primary care group Iora Health. Continue Reading
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03 Jun 2021
Sentara-Cone Health Merger Called Off Amid Consolidation Concerns
The canceled healthcare merger deal prompted a statement from North Carolina’s AG warning about hospital consolidation and its impact on prices. Continue Reading
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02 Jun 2021
Federal Loan Repayment Alleviating Severe Clinician Shortages
Loan repayment and scholarships through National Health Service Corps programs are going to providers practicing in areas with the most severe clinician shortages, but more providers are still needed. Continue Reading
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28 May 2021
Physician Compensation Plateaus Despite Pandemic Losses
Physician compensation stayed the same or marginally increased for most specialties in 2020 compared to 2019, an MGMA report reveals. Continue Reading
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26 May 2021
April Hospital Revenue, Volume Improve as COVID-19 Losses Linger
Hospital financial performance improved in April, but margins are still thin as hospital revenue recovers from COVID-19, a report from Kaufman Hall shows. Continue Reading
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25 May 2021
How AI is Driving Patient Financial Experience Excellence
Revenue cycle management is a strong use case for AI in healthcare, but the technology can go beyond cost-savings by improving the patient financial experience. Continue Reading
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21 May 2021
Safety-Net Hospital Profitability Sinks as Demand Rises
Safety-net hospitals help the most vulnerable populations. But a lack of profitability has them struggling to survive even as wealthy hospitals thrive. Continue Reading
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20 May 2021
Physician Recruitment Drops, Number of Medical Residents Rises
New physician recruitment is significantly lower than past years, but the number of US medical residents increased in 2020 despite high rates of physician burnout. Continue Reading
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19 May 2021
Prior Authorization Challenges Persist, AMA Survey Reveals
Prior authorization still presents challenges to physicians, three years after the AMA and other health organizations released a consensus statement urging reform. Continue Reading
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18 May 2021
Automating Patient Financial Clearance Cuts Denials, Boosts Payments
South County Urological has seen COB denials drop 75% and patient payments increase 15% with the help of patient financial clearance automation, much to the satisfaction of patients. Continue Reading
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17 May 2021
Price, Reputation Turn Away Revenue Cycle Outsourcing Customers
Meanwhile, experience with an EHR vendor, expertise, and relationship were motivating factors when it came to revenue cycle outsourcing selections, KLAS reports. Continue Reading
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13 May 2021
Mid-Revenue Cycle Management Market to be Worth $4.55B by 2027
The mid-revenue cycle management market is projected for significant growth due to the increasing need to manage healthcare data, improve financial outcomes, and resolve medical billing errors. Continue Reading
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12 May 2021
Patient Self-Service Drives Revenue Growth at Inspira Health
Patient self-service, such as online bill pay, not only accelerated payments but also drove revenue growth to the tune of $1.5M at Inspira Health. Continue Reading
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12 May 2021
AHA: Let Hospitals Use COVID-19 Relief Funds Through PHE
HHS has set a deadline of June 30th for providers to use COVID-19 relief funds sent to them by the CARES Act and other pandemic legislation. Continue Reading
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11 May 2021
Study Finds High Rates of Low-Value Care, But Hospitals Disagree
The American Hospital Association is pushing back against a recent study that found hospitals deliver low-value care services every 80 seconds. Continue Reading
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10 May 2021
For Healthcare Financial Transformation, Cultural Change is Key
Changing the culture was key to shifting from an annual to rolling budgeting process at John Muir Health as part of a healthcare financial transformation effort. Continue Reading
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10 May 2021
COVID-19 Recovery Requires Staffing Stability, Patient Engagement
Industry leaders said that practices should focus on patient engagement and staffing stability to achieve pre-COVID-19 patient volumes and revenue. Continue Reading
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10 May 2021
Key Ways Patient Identity Management Boosts the Bottom Line
A comprehensive patient identity management strategy can prevent costly billing errors and prime organizations for more sophisticated payment models. Continue Reading
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06 May 2021
Less Than Half of Physicians Work in a Private Practice, AMA Finds
Just 49% of physicians worked in a private practice in 2020, down from 54% of physicians in 2018, according to a new AMA analysis. Continue Reading
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06 May 2021
Why Patient Access is Key to Revenue Cycle Management Success
Patient access is the first point of contact for patients and the first time staff can get key information right for revenue cycle management success. Continue Reading
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04 May 2021
Vertical Integration in Healthcare Impacting Referral Patterns
More physician referrals are for hospital-based services after vertical integration in healthcare, resulting in higher costs and low-value care, two new studies show. Continue Reading
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04 May 2021
Workforce Management Key to Nurse Mental Health, Patient Safety
Nurses who reported poor physical and mental health were up to 61 percent more likely to make medical errors, prompting pushes for workforce management. Continue Reading
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03 May 2021
Fewer Primary Care Practices Struggling A Year After COVID-19
A new survey showed that just 7% of primary care practices cannot pay their bills, but the situation is still not ideal for these providers a year after COVID-19. Continue Reading
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03 May 2021
75% of Health Systems Deployed RCM Technology During Pandemic
A new survey shows that health systems have been actively engaging with revenue cycle management optimization during the pandemic through RCM technology. Continue Reading
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29 Apr 2021
St. Vincent Staffing Strike For Patient Safety Improvements Continues
Nurses at St. Vincent Hospital march on after Tenet Healthcare did not address their patient safety staffing concerns that prompted the strike. Continue Reading
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29 Apr 2021
Lean Management in Healthcare Lowers Costs, Improves Quality
Implementation of lean management in healthcare is strongly associated with better performance on quality, cost, and patient experience measures, study shows. Continue Reading
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28 Apr 2021
Kaiser Permanente Paying $11.5M in Equal Pay, Racial Equity Case
The settlement resolve a class-action lawsuit alleging the health system engaged in racial discrimination, denying equal pay to Black employees. Continue Reading
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27 Apr 2021
Narrow Margins, Low Patient Volumes Beleaguer Hospital Revenue
Physician groups and hospitals continue to experience narrow profit margins, low patient volumes, and high costs due to the COVID-19 pandemic. Continue Reading
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26 Apr 2021
Understanding A/R Productivity is Key to Revenue Cycle Success
Gaining a clear picture of accounts staff are working and other productivity measures is crucial to managing denials and increasing collections for revenue cycle management success. Continue Reading
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22 Apr 2021
Nurses Say Supply Chain Problems Impact Safety, Hospital Margins
Four out of five nurses call for supply chain automation tools that would improve patient safety, reduce stress, and increase hospital revenue. Continue Reading
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21 Apr 2021
UVA Health Drops Lawsuits Over Patient Financial Responsibility
The Virginia health system updated its patient financial responsibility collection policies this week to “reflect fair and financially responsible guidelines based upon a patient’s ability to pay.” Continue Reading
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19 Apr 2021
OIG: Do Not Charge, Balance Bill Patients for COVID-19 Vaccines
HHS OIG released a message to healthcare providers after receiving complaints from patients that they are being charged by providers for COVID-19 vaccines. Continue Reading
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15 Apr 2021
House Reps Urge HHS To Enforce Hospital Price Transparency Rule
More than half of the 100 largest hospitals in the country are noncompliant with the price transparency rule which aims to increase competition. Continue Reading
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15 Apr 2021
Urgent Care Increases Lower-Acuity Spending, Deters Some ED Visits
Despite a tenfold higher price per visit for emergency departments, urgent care centers have increased net overall spending on lower-acuity care. Continue Reading
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14 Apr 2021
Third of Hospitals, Systems Don’t Use Revenue Cycle Automation
Most of these hospitals and health systems have never used revenue cycle automation, but plan to do so by the end of 2021. Continue Reading
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13 Apr 2021
Hospital Price Transparency Rule Compliance Is Inconsistent
Hospital price transparency tools lack data standardization, leading to inaccurate pricing comparisons for consumers, payers, and employers. Continue Reading
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08 Apr 2021
COVID-19 Spurs Fewer, But Larger Hospital Merger, Acquisition Deals
Hospital merger and acquisition activity was down at the start of 2021, but larger hospitals and health systems were still active. Continue Reading
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07 Apr 2021
CMS Resumes All Hospital Surveys As COVID-19 Cases Lessen
All hospital survey activities, including non-immediate jeopardy complaints, have been resumed by CMS as the number of COVID-19 cases decrease. Continue Reading
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07 Apr 2021
Gender, Racial Disparities in COVID-19 Workforce Stress Levels
Amidst COVID-19, women of color with children under age 18 reported high stress levels related to caregiving, productivity, and career development. Continue Reading
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06 Apr 2021
Physicians Collect More From Surprise Medical Bills in ED
A study shows that physicians collected 65% of the charged amount for likely surprise medical bills from emergency department visits versus 52% in other cases. Continue Reading
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05 Apr 2021
Healthcare Supply Chain Still Fragile A Year After COVID-19
New data from Premier shows that the healthcare supply chain is still “fragile and constrained” despite greater availability of personal protective equipment. Continue Reading
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31 Mar 2021
Medical Liability Premium Increase Draws Practice Viability Concern
Over 30 percent of premiums increased in 2020, up from 13.7 percent in 2018, a cause of industry concern for care access and practice viability. Continue Reading
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29 Mar 2021
Top 5 Trends Impacting Healthcare Revenue Cycle Management
Remote work, new consumer debt rules, and high patient financial responsibility are some of the trends creating a new normal for healthcare revenue cycle management. Continue Reading
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25 Mar 2021
Key Ways Providers Can Prepare for New Surprise Billing Rules
Providers should be preparing now for new surprise billing rules slated to take effect next year under the No Surprises Act. Continue Reading
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24 Mar 2021
WA Provider Files Complaint Against Cerner in Bankruptcy Court
Astria Health is seeking damages from Cerner after the health system claimed collection rates plummeted following implementation of the vendor’s billing system. Continue Reading
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24 Mar 2021
39% of Hospitals to Operate in Red Despite Vaccine Rollout
Operating margins will be negative for more hospitals compared to the pre-pandemic period even if vaccine rollout goes smoothly and COVID-19 hospitalizations drop. Continue Reading
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23 Mar 2021
Price Transparency to Digital Billing, Unlocking Financial Experience
Carilion Clinic is not only unlocking the digital front door with price transparency but helping patients on the other side with new billing & collections options. Continue Reading
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18 Mar 2021
Major Hospitals Still Not Complying with Price Transparency Rule
Nearly two-thirds of the largest hospitals in the US have yet to fully comply with the new price transparency rule, with most missing payer-specific charges. Continue Reading
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17 Mar 2021
RCM Automation Boosts Practice’s Accounts Receivable Efficiency
RCM automation at Key-Whitman Eye Center in Texas helped to decrease aging accounts receivable by 38% by increasing staff efficiency and prioritizing queues. Continue Reading
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12 Mar 2021
Judge Approves Sutter Health’s $575M Antitrust Settlement
The antitrust settlement will resolve allegations that Sutter Health engaged in anticompetitive practices, resulting in higher healthcare prices for self-funded plan members. Continue Reading
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12 Mar 2021
Physician Retention Challenges Worsen Amid COVID-19
A survey shows that 70% of physicians are disengaging from their employers, spelling future physician retention trouble for healthcare organizations. Continue Reading
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09 Mar 2021
Yale New Haven Health Streamlines Patient Billing Experience
Balancing people and technology is helping Yale New Haven Health streamline and personalize the complex patient billing experience, from registration to final bill payment. Continue Reading
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03 Mar 2021
Einstein-Jefferson Healthcare Merger On After FTC Drops Challenge
The Pennsylvania-based academic medical centers will move forward with a proposed healthcare merger deal that will create an 18-hospital system. Continue Reading
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01 Mar 2021
Providers Seek Consulting Partners for ERP Implementation
A new report explores the types of consulting partners being leveraged for ERP implementation success and which firms are leading to faster results. Continue Reading
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25 Feb 2021
Non-Coronavirus Hospital Admissions Drop Again
Hospital admissions for reasons other than COVID-19 dropped to about 80% of predicted levels nationally by the start of December as patients potentially delayed care. Continue Reading
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24 Feb 2021
Lifespan, Care New England Unveil Merger Plans with Brown University
Rhode Island’s predominant health systems signed a definitive agreement to merge and create, with Brown University, an integrated, academic health system. Continue Reading
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24 Feb 2021
Rocky Hospital Financial Performance Suggests Long Road to Recovery
Hospital financial performance suffered in January 2021 despite some reprieve from the winter COVID-19 surge, indicating many more months of financial hardship. Continue Reading
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23 Feb 2021
How a Safety-Net Hospital Maintains a Patient-Centered Revenue Cycle
Montefiore St. Luke’s Cornwall Hospital in New York exists to serve its community, so leaders have extended that idea to the revenue cycle. Continue Reading
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18 Feb 2021
Medicare FFS Utilization Declined Across the Board During COVID-19
New data shows that Medicare FFS utilization declined significantly at the start of the COVID-19 pandemic, with outpatient claims taking the largest hit. Continue Reading
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18 Feb 2021
3 Trends That Will Drive Healthcare Revenue in the Future
The end of the general hospital, less mass-produced therapies, and a change in how healthcare is financed will drive 85% of healthcare revenue, experts predict. Continue Reading
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16 Feb 2021
Clinical Documentation Improvement Vendors Gaining Momentum
Iodine, Optum, and 3M are some of the clinical documentation improvement vendors that have boosted market energy over the last 2 years, according to KLAS. Continue Reading
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12 Feb 2021
Resource Constraints Trouble Hospital Price Transparency Compliance
Hospitals not complying with the hospital price transparency rule cite resource constraints, lack of understanding, and a wait-and-see mentality. Continue Reading
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11 Feb 2021
CARES Act Funding Will Lead to More Healthcare Fraud Accusations
The government is likely to pursue more healthcare fraud cases through the False Claims Act in the wake of the COVID-19 pandemic, lawyers predict. Continue Reading
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04 Feb 2021
Direct Primary Care Increases Patient-Centered Care Access
The direct primary care model could boost care access in Massachusetts by providing patient-centered care at affordable monthly costs. Continue Reading
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03 Feb 2021
COVID-19 Increases Rural Hospital Closure Risk, Care Access Concern
The risk of rural hospital closures has been on the upswing since COVID-19, drawing concern for care access and community health across the nation. Continue Reading
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02 Feb 2021
KLAS: Epic, MEDITECH Continue to Lead Patient Accounting Solutions
Also among this year’s revenue cycle winners are Quadax for claims management, Strata Decision Technology for business decision support, and Patientco for patient financial engagement. Continue Reading