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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29 Jan 2021
Will Hospital Patient Visits Return to Normal in 2021?
A new analysis indicates that hospital patient visits are unlikely to return to pre-pandemic levels this year despite some change in volumes. Continue Reading
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28 Jan 2021
Staffing, Cost Management Top 2021 Priorities for Medical Groups
2020 provided some major lessons learned for medical groups, prompting them to prioritize items like staffing shortages and revenue and cost management to succeed in 2021. Continue Reading
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27 Jan 2021
Rolling Forecasts, Budget Flexibility Key 2021 Health Finance Trends
Finance teams are planning to increase budget flexibility using rolling forecasting in 2021 following a year of unexpected turns in healthcare. Continue Reading
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22 Jan 2021
A New Administration, Value-Based Payment to Dictate 2021 Success
Revenue cycle and finance professionals are up against a lot of uncertainty as a new administration takes over, but value-based payment could be the intersection of provider and policy. Continue Reading
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21 Jan 2021
Not All Hospitals Complying with New Price Transparency Rule
An analysis found inconsistent and incomplete pricing information among the top 20 US hospitals subject to new price transparency requirements from CMS. Continue Reading
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19 Jan 2021
FTC Announces Plan to Study Physician Group Mergers
The federal agency has issued a call for claims data in order to study the effects of recent physician group mergers and hospital acquisitions of practices. Continue Reading
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18 Jan 2021
CMS Cost Reporting Delayed as Hospitals Question Proposed Changes
CMS pushed back the filing deadline for hospital cost reporting requirements because of COVID-19; AHA asks agency to reconsider proposed changes to worksheets. Continue Reading
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14 Jan 2021
Medical Staff Credentialing Vendors Meeting New Telehealth Needs
Getting providers onboarded was critical during the COVID-19 crisis; medical staff credentialing vendors were up to the task, users say. Continue Reading
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13 Jan 2021
COVID-19 a Catalyst for Healthcare Merger and Acquisition Activity
The COVID-19 pandemic did not halt healthcare merger and acquisition actvitiy in 2020 and could be the catalyst for strategic transactions in the new year. Continue Reading
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08 Jan 2021
3 Key Steps for Hospital Price Transparency Compliance
Hospitals must post standard charges, including private payer rates, in a machine-readable and consumer-friendly format for price transparency compliance. Continue Reading
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07 Jan 2021
CHI Franciscan, Virginia Mason Complete Healthcare Merger
The healthcare merger deal ends with the formation of Virginia Mason Franciscan Health, an 11-hospital system with nearly 300 care sites in the Pacific Northwest. Continue Reading
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06 Jan 2021
COVID-19 Nurse Staffing Demand Increased 245% During Fall Surge
Hospitals needed about 50k more nurses to meet COVID-19 nurse staffing demand as more facilities reached ICU capacity during the fall of 2020, Epic reports. Continue Reading
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06 Jan 2021
Medicaid Expansion Still Boosting Hospital Finances
The early positive impact of Medicaid expansion on hospital finances has persisted, possibly putting hospitals in expansion states at an advantage with COVID-19. Continue Reading
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04 Jan 2021
How Time-Driven Costing in Healthcare Boosts Staffing, Revenue Cycle
Armed with modern data analytics, Montefiore was able to leverage time-driven costing in healthcare to first optimize staffing, then revenue cycle operations. Continue Reading
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31 Dec 2020
KLAS: Epic, MEDITECH Lead Patient Accounting Vendors
Providers rated Epic and MEDITECH the highest among patient accounting system vendors in terms of overall performance, KLAS reports. Continue Reading
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30 Dec 2020
Top Healthcare Fraud Takedowns of 2020
2020 was a landmark year for healthcare fraud takedowns, with law enforcement officials charging over 300 individuals for schemes involving more than $6B in fraudulent claims. Continue Reading
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29 Dec 2020
Independent Medical Groups Increased Profit Per Provider in 2019
A new AMGA report shows that independent medical groups generated a profit the year before COVID-19 hit, while health-system affiliated groups lost money. Continue Reading
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29 Dec 2020
Providers Seek to Stop Hospital Price Transparency Enforcement
Several provider groups have requested an emergency motion for stay of hospital price transparency enforcement on Jan. 1 in light of the ongoing COVID-19 pandemic. Continue Reading
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28 Dec 2020
Predictive Healthcare Forecasting Key to Provider Survival in 2021
Providers will need to execute a more predictive healthcare forecasting strategy to survive the uncertainty of 2021, industry experts say. Continue Reading
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23 Dec 2020
10 Hospital Service Lines Most Impacted by COVID-19
The ongoing COVID-19 pandemic continues to impact key hospital service lines, with some faring worse than others because of changes in consumer behavior. Continue Reading
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22 Dec 2020
Latest COVID-19 Surges Impact Hospital Operating Margins
Hospital operating margins fell in November as rates of infection and COVID-19 hospitalizations increased yet again across the country, according to a new report. Continue Reading
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22 Dec 2020
CMS to Audit Some Hospitals for Price Transparency Compliance
The agency has said it will audit a sample of hospital websites to ensure price transparency rule compliance starting Jan. 1, 2021. Continue Reading
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18 Dec 2020
Year in Review: Most Read Revenue Cycle Management Stories of 2020
From COVID-19 coding to caring for the uninsured, we look back at the revenue cycle management stories that caught reader eyes in 2020. Continue Reading
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15 Dec 2020
Rapid Pace of Health System Consolidation to Continue, Experts Say
Health system consolidation has already occurred at a rapid pace and this trend is likely to continue as providers strive to deliver more virtual, consumer-centric care, Deloitte experts predict. Continue Reading
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11 Dec 2020
Healthcare Facilities Implement PPE Crisis Standards of Care
While providers have better access to a supply of personal protective equipment compared to the spring, most facilities are implementing PPE crisis standards of care as COVID-19 surges again. Continue Reading
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10 Dec 2020
Court Rejects FTC Case Against Philly Healthcare Merger Deal
A federal district court blocked FTC’s attempt to stop the healthcare merger deal between two Philadelphia-based health systems, Jefferson Health and Einstein Health Network. Continue Reading
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09 Dec 2020
Primary Care Spending Declining Despite Well-Known Health Benefits
Primary care spending declined to 4.67% in 2019 from 4.88% in 2017 even though higher spending was associated with fewer ED visits and hospitalizations, a new report shows. Continue Reading
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09 Dec 2020
VillageMD, Walgreens to Open 40 Primary Care Clinics in 2021
The primary care clinics will be open by the end of summer 2021 and provide a more integrated, convenient experience for patients at a lower cost, the companies stated. Continue Reading
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07 Dec 2020
Intermountain-Sanford Deal Off, Other Healthcare Merger News
Intermountain and Sanford Health have stopped a potential healthcare merger amid executive changes, while the FTC tried to block a proposed acquisition in New Jersey. Continue Reading
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07 Dec 2020
Managing Telemedicine Risks During the COVID-19 Pandemic
Important steps should be taken now to reduce liability for this nontraditional care option. Continue Reading
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03 Dec 2020
Provider Groups Update Guidance on Maintaining Surgery Amid COVID-19
As COVID-19 cases continue to rise, four leading industry groups are giving providers an updated roadmap for maintaining elective surgery during the pandemic. Continue Reading
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02 Dec 2020
Hospital Margins, Volumes Still Falling Months into Pandemic
Hospital operating margins were down again in October, resulting in a nearly 70% reduction in performance year-to-date, as volumes continued to underperform during the COVID-19 pandemic. Continue Reading
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30 Nov 2020
Medical Billing a Challenge for Struggling Primary Care Practices
Over half of primary care clinicians say their practice is overwhelmed by constantly changing medical billing rules and some are having to alter processes to accommodate new patient needs. Continue Reading
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25 Nov 2020
3 Ways Health Systems Are Preparing for a COVID-19 Vaccine
A new survey found that 90% of health system leaders do not feel state or federal governments have fully prepared them for receiving and managing a COVID-19 vaccine. Continue Reading
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25 Nov 2020
Slow Hospital Visit Recovery Suggests Telehealth Here to Stay
Hospital visit recovery across key metrics is still down compared to pre-pandemic levels, and new consumer research suggests volumes could stay low as patients prefer telehealth services. Continue Reading
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24 Nov 2020
Breaking from Traditional Healthcare Budgeting During Modern Times
John Muir Health was in the process of implementing dynamic healthcare budgeting when COVID-19 hit, but the non-traditional process actually supported health system financial stability during the pandemic. Continue Reading
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20 Nov 2020
FTC Looks to Block Acquisition of 2 Tenet Hospitals in Memphis
The federal agency is suing to stop Memphis-based Methodist Le Bonheur Healthcare from purchasing two local hospitals owned by Tenet for $350M. Continue Reading
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19 Nov 2020
As COVID-19 Surges Again, Hospital Staffing Shortages Worsen
Hospital staffing shortages are impacting about 22% of facilities, up from 19% last week, The Atlantic reports. Continue Reading
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18 Nov 2020
Healthcare Providers Tell Trump to Give Biden COVID-19 Data ASAP
Exchanging critical COVID-19 data with the Biden transition team can prevent a potential lapse in provider ability to care for patients, said AHA, AMA, and ANA in a new letter. Continue Reading
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16 Nov 2020
Vital Insights from 10 Years of Malpractice Claims
Despite efforts to improve patient safety over the past 20 years, new data suggests that results have not been optimal. Continue Reading
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13 Nov 2020
Providers Overhauling Patient Collections Strategies For COVID-19
Nearly 1 in 5 providers say they are overhauling their entire patient collections strategies because of COVID-19, a new survey shows. Continue Reading
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12 Nov 2020
Rural-Urban Primary Care Workforce Disparities on the Rise
From 2009 to 2017, the density of primary care clinicians increased overall, but urban communities saw a larger primary care workforce increase than rural communities. Continue Reading
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10 Nov 2020
CDC: 1 in 11 COVID-19 Inpatients Experience a Hospital Readmission
About 1.6% of the COVID-19 patients with a hospital readmission were readmitted more than once, according to the new CDC study. Continue Reading
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09 Nov 2020
Shifting the Mindset for Staff Modeling in Emergency Medicine
Practice leaders will need more insight into staff modeling in emergency medicine in order to overcome the disruptions caused by COVID-19 and its aftermath. Continue Reading
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06 Nov 2020
Patients Want Healthcare Price Transparency, But Few Seek It Out
7 out of 10 consumers in a recent survey said they would like to know provider prices, yet over half also said they never thought of seeking the information despite healthcare price transparency laws. Continue Reading
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05 Nov 2020
Variation in Medicare Spending Narrows as Top-Spenders Cut Costs
Hospital referral regions with the highest Medicare spending rates in 2007 had the lowest growth rates through 2017, indicating the success of certain healthcare payment reforms. Continue Reading
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03 Nov 2020
81% of Physicians Still Providing Fewer In-Person Visits, AMA Finds
The loss of in-person visits coupled with higher-than-normal expenses threatens physician practice viability, the American Medical Association says. Continue Reading
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02 Nov 2020
A Specialty Group’s Revenue Cycle Automation Journey
Revenue cycle automation has been a process, not a destination for Columbia Orthopaedic Group, and so far, automated financial clearance and A/R workflows have improved efficiency. Continue Reading
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30 Oct 2020
10 Major Healthcare Merger & Acquisition Deals Announced in 2020
The COVID-19 pandemic has not slowed healthcare merger and acquisition activity in 2020, with several provider organizations making transformational moves. Continue Reading
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29 Oct 2020
Health Systems Losing Money on Employed Physicians During COVID-19
Health systems are facing a mean subsidy, or loss, of $227K per employed physician, while hospitals continue to underperform due to COVID-19, Kaufman Hall reports. Continue Reading
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28 Oct 2020
3 Strategies for Medical Practice Excellence in the Era of COVID-19
Industry leaders at MGMA’s Medical Practice Excellence Conference shared their best practices for remaining financially and operationally stable in the era of COVID-19. Continue Reading
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26 Oct 2020
Intermountain, Sanford Announce Intended Healthcare Merger Deal
The healthcare merger deal, expected to close in 2021, will employ more than 89,000 individuals and operate 70 hospitals, many of which will be located in rural communities. Continue Reading
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23 Oct 2020
Best Practices When Outsourcing Revenue Cycle Management
Providers are facing one of the worst economic crises of modern times. Outsourcing full revenue cycle management to a third party could help some cut costs while focusing on patient care. Continue Reading
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22 Oct 2020
Providers Want Innovation, Disruption for Revenue Cycle Management
In fact, health system leaders in a new report said revenue cycle management was the area in healthcare that has the greatest need for innovation and disruption like AI. Continue Reading
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21 Oct 2020
Over 40% of Hospitals Seeing Bad Debt, Uncompensated Care Increase
Hospital execs in a new survey also reported increases in uninsured, self-pay, and Medicaid patients, which when coupled with high expenses and low volumes spells trouble for hospital financial viability. Continue Reading
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20 Oct 2020
Successful Practices Invest in Business Office, Clinical Support
MGMA’s top-performing practices reported 20% more staff in the business office and 18% more nursing staff than the median multispecialty practice, resulting in greater practice productivity. Continue Reading
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19 Oct 2020
Baptist Memorial Health Care Enhances Patient Collections with IVR
Offering convenient payment options is key to optimizing patient collections, but a health system in Tennessee has found a way to provide that convenience whenever patients want it. Continue Reading
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19 Oct 2020
How Anesthesiologists Can Keep The Revenue Cycle From Going Under
COVID-19, contract terminations, and rate cuts are slowing the anesthesiologist’s revenue cycle, but a technology-driven strategy with a focus on patient experience can help practices maintain financial stability and maximize revenue. Continue Reading
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16 Oct 2020
Top 4 Hospital Chargemaster Management Challenges
Hospital chargemaster management comes with a host of challenges, but overcoming them is key to financial health and effective healthcare price transparency. Continue Reading
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13 Oct 2020
How Sharp HealthCare is Winning at Revenue Cycle Management
A gamified approach to revenue cycle management increased productivity by up to 31% in some areas, while giving staff and leadership more transparency and accountability. Continue Reading
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12 Oct 2020
Atrium Health, Wake Forest Baptist Health Finalize Merger
The two health systems recently completed a healthcare merger deal to create an $11 billion “next-generation academic health system.” Continue Reading
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08 Oct 2020
Healthcare Merger and Acquisition Activity Increased in Q3 2020
19 healthcare merger and acquisition transactions were announced in Q3 2020, up from 14 transactions in Q2 2020 and on par with historical third-quarter activity, Kaufman Hall reports. Continue Reading
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07 Oct 2020
What Contributes to High US Healthcare Spending?
US healthcare spending is nearly twice as much as the average in peer nations, driven by inpatient and outpatient payments, prescription drug prices, and administrative costs. Continue Reading
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06 Oct 2020
How Revenue Cycle Technology Got Patients Back to the Office
Patient volumes have exceeded pre-pandemic levels for Family Practice Associates of Lexington PSC thanks to patient engagement and revenue cycle technology. Continue Reading
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06 Oct 2020
Advocate Aurora, Beaumont Health Call Off Healthcare Merger Deal
The health systems will not move forward with healthcare merger discussions after putting a potential partnership deal on hold during the pandemic. Continue Reading
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05 Oct 2020
Navigating the Public Health Emergency in Emergency Medicine
As the COVID-19 crisis continues, independent physician groups in emergency medicine must be proactive in learning the landscape. Continue Reading
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01 Oct 2020
Hospital Revenue Cycle IT Budgets to Take a Hit After COVID-19
A new analysis uncovers hospital projections over the next 12 months, including plans for revenue cycle IT budgets and payer mix changes. Continue Reading
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29 Sep 2020
August Was a Setback for Hospital Financial Recovery, Report Shows
Operating margins fell both month-over-month and year-over-year after three months of moderate growth, the latest hospital financial recovery data from Kaufman Hall found. Continue Reading
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28 Sep 2020
A Unique IPA Centers on Social Determinants of Health
An IPA of community-based organizations is forging contracts with payers to address social determinants of health in a way that generates ROI and sustainable programs. Continue Reading
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24 Sep 2020
How FTC’s New Merger Retrospective Program Will Impact Healthcare
The revamped program will expand the FTC’s retrospective research efforts, which could signal increased scrutiny of certain healthcare merger deals in the future. Continue Reading
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24 Sep 2020
Clinicians Overwhelmingly Agree Primary Care Has Not Rebounded
1 in 3 clinicians in a new survey report FFS volume is 30 to 50% below pre-pandemic levels and will likely remain that way for a while. Continue Reading
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21 Sep 2020
How Independent Practices Can Come Out of COVID-19 Stronger
The economic fallout of COVID-19 may accelerate acquisitions of independent practices unless practice leaders consider new, but not necessarily novel, ways of doing business. Continue Reading
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21 Sep 2020
How Emergency Departments Can Overcome Revenue Cycle Challenges
The COVID-19 pandemic has created a host of revenue cycle challenges for emergency departments, but a data-driven approach can keep facilities stable during an uncertain time. Continue Reading
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18 Sep 2020
Top Ways to Improve Collection of Patient Financial Responsibility
High deductibles and a potential surge in self-pay patients is making it difficult for providers to collect patient financial responsibility. Here are 4 ways to optimize collection even during a pandemic. Continue Reading
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17 Sep 2020
ED, Inpatient Volumes Stuck Despite Some Hospital Visit Recovery
Hospital visit recovery is still a mixed bag with some areas returning to pre-pandemic levels sooner than others, a new analysis shows. Continue Reading
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15 Sep 2020
Health Systems Considering Remote Revenue Cycle Management
A new survey found that 75% of health systems and large hospitals are considering permanent changes to revenue cycle management due to COVID-19, including more work from home positions. Continue Reading
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14 Sep 2020
Enterprise Strategy for Revenue Cycle Tech Not Fully Realized Yet
A new KLAS report found that no advanced users are using one revenue cycle technology vendor for all revenue cycle needs, but interest is there. Continue Reading
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04 Sep 2020
Provider Compensation Rose 3.79% But Is Low Productivity a Problem?
AMGA’s latest provider compensation report finds that pay is going up while productivity remains stagnant, which could pose a problem in a COVID-19 world. Continue Reading
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02 Sep 2020
Primary Care Is Staying Open, But Practice Management Issues Persist
Primary care practice management challenges include increased clinician workloads, environmental threats, and a lack of resources, according to a new survey. Continue Reading
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31 Aug 2020
Providers Confused by COVID-19 Coding, Claim Requirements
A new survey shows that confusion over COVID-19 coding and claim requirements is one of the top impacts the pandemic has had on revenue cycle operations. Continue Reading
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31 Aug 2020
Is the Doctor’s Office Dead? Practice of Primary Care Goes Virtual
The office-based business model has led to massive financial losses during COVID-19, while virtual primary care providers have been able to remain operational. Continue Reading
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28 Aug 2020
Can Direct Primary Care Lead Private Practice Out of the Hole?
Primary care practices are suffering losses of over $15 billion because of COVID-19 but direct primary care physicians are reporting little change in revenue and better patient and clinician satisfaction. Continue Reading
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27 Aug 2020
Private Equity-Acquired Hospitals Charge More for Common Services
The hospitals also demonstrated higher net annual income, case mix index, and quality measure performance in three years after acquisition by a private equity firm, a new study shows. Continue Reading
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26 Aug 2020
Average Physician Assistant Compensation Grew to $111K in 2019
The average physician assistant compensation rate represented 3.3% growth compared to 2018, the American Academy of PAs reports. Continue Reading
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25 Aug 2020
Hospital Operating Margins Down 96% As Volumes Remain Low
Despite being down compared to last year, hospital operating margins increased 24% month-over-month as providers reopen and recover from the peak of COVID-19. Continue Reading
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25 Aug 2020
Lawsuit Alleges HCA Endangers Workers, Community During COVID-19
The first-in-the-nation lawsuit claims the largest hospital owner and one of its community hospitals “recklessly facilitated the spread of COVID-19” by forcing sick employees work during the pandemic. Continue Reading
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24 Aug 2020
After COVID-19, Radiology to Rethink Revenue Cycle Management
More Medicaid and self-pay patients, fewer radiologists, and a greater need for efficiency should prompt radiology practices to optimize revenue cycle management. Continue Reading
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21 Aug 2020
Could COVID-19 Spell the End of Independent Physician Practices?
59% of physicians anticipate COVID-19 to reduce the number of independent physician practices in their communities, while half think hospitals will exert stronger influence after the pandemic. Continue Reading
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20 Aug 2020
Outpatient Volumes Plateau, Except in COVID-19 Hot Spots
Weekly outpatient volumes plateaued at 10% below pre-pandemic levels by Aug. 1, but the cumulative loss is still substantial and growing, the Commonwealth Fund said. Continue Reading
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14 Aug 2020
Provider Consolidation Substantial, Particularly Among Physicians
A new study found that more than half of US physicians and 72% of hospitals were affiliated with a health system in 2018, representing “substantial” provider consolidation. Continue Reading
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11 Aug 2020
AHA Wants More Payback Options for Accelerated Medicare Payments
PIP hospitals should be able to carry out their accelerated Medicare payment repayment at cost settlement, while other hospitals should be able to make payments to MACs, the group said. Continue Reading
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10 Aug 2020
Providers Fear Growing Uninsured Rate to Keep Patient Volumes Down
Nearly three-quarters of providers are concerned that newly uninsured patients will continue delaying care, leading to worsening conditions and independent practice closures. Continue Reading
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06 Aug 2020
Surprise Billing Action Needed, But Hospitals Urge Congress to Wait
A new report from HHS underscores the urgent need for a federal surprise billing solution, but AHA and other hospital groups hope Congress will wait until after the COVID-19 pandemic. Continue Reading
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29 Jul 2020
Hospitals Can Sell Patient Bad Debt to Charitable Orgs, OIG Says
A new advisory opinion says a medical debt forgiveness company would be able to purchase patient bad debt directly from hospitals without triggering the Anti-Kickback Statute. Continue Reading
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27 Jul 2020
Optimizing Self-Pay Collection to Aid Patients, Revenue During COVID-19
As unemployment continues to rise as a result of the pandemic, providers need to optimize self-pay collection strategies to help patients and revenue collection during this difficult time. Continue Reading
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24 Jul 2020
Healthcare Revenue Cycle Recovery After the COVID-19 Pandemic
Financial losses from the COVID-19 pandemic will have lasting effects on providers but leveraging some of the capabilities developed during crisis can build a more resilient healthcare revenue cycle. Continue Reading
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23 Jul 2020
New Physician Compensation, Recruitment Take a Hit During Pandemic
New physician compensation is likely to decline temporarily as the number of new recruiting engagements drops by over 30% compared to last year, Merritt Hawkins reports. Continue Reading
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23 Jul 2020
Half of Hospitals to Operate in the Red By Year's End
Hospital margins could sink to -7% in the second half of 2020, with about half of all US hospitals operating in the red because of COVID-19, according to the AHA. Continue Reading
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22 Jul 2020
COVID-19 Test Prices Set by Hospitals Range from $20 to $850
Over half of hospitals set COVID-19 test prices between $100 and $199, but some facilities charge as much as $850 for the diagnostic test alone, while others charge as little as $20, an analysis shows. Continue Reading
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15 Jul 2020
Healthcare Providers Receive Most Paycheck Protection Program Loans
Social assistance and healthcare providers received nearly 13% of Paycheck Protection Program loans through the end of June, topping the list of sectors garnering the potentially forgivable loans. Continue Reading