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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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
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08 Jul 2020
How Providers, Suppliers Aim to Shore Up the Healthcare Supply Chain
Providers and suppliers plan to overcome healthcare supply chain obstacles created by COVID-19 by prioritizing US-made goods, gathering more inventory and demand planning data, and relying less on IT. Continue Reading
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07 Jul 2020
Layoffs Continue as Primary Care Braces for Return to Pre-COVID Pay
Over a third of primary care practices have laid off or furloughed staff in the last 4 weeks as cash on hand continues to dwindle and leaders prepare for a return to normal telehealth payment policies. Continue Reading
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06 Jul 2020
Hospital Merger and Acquisition Activity Withstands COVID-19 Slump
COVID-19 had a less dramatic decline in hospital merger and acquisition activity, with two major deals announced in June, Kaufman Hall reports. Continue Reading
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29 Jun 2020
AAMC Predicts Physician Shortage to Hit Between 54K to 139K by 2033
The physician shortage is projected to worsen compared to previous estimates as the population grows and ages, AAMC reported. Continue Reading
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25 Jun 2020
Healthcare Enterprise Resource Planning Systems Going to the Cloud
A KLAS market report finds that providers are replacing or selecting new healthcare enterprise resource planning systems to move to the cloud. But cloud solutions are coming with their fair share of challenges. Continue Reading
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25 Jun 2020
1 in 5 Adults Reporting Job, Coverage Disruption Now Uninsured
COVID-19 has spurred an uptick in uninsured patients, resulting in a growing demand for new options to buy health insurance, a survey shows. Continue Reading
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24 Jun 2020
Efficiency Key to Health System Financial Stability After COVID-19
As Eisenhower Health reopens following the peak of COVID-19, leaders are leaning on technology and strategies that improve efficiency to ensure health system financial stability during the recession. Continue Reading
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22 Jun 2020
Mobile Tech Key to Patient Financial Experience During COVID-19
Mobile technology brings the patient financial experience where healthcare consumers are, eliminating points of friction and ensuring safety during the COVID-19 crisis. Continue Reading
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19 Jun 2020
Medical Groups At Least A Year Away from Recovering Revenue Losses
Most medical groups and health systems expect to overcome COVID-19 revenue losses in a year or more, but about a quarter are still unsure when or if they will ever return to pre-COVID levels, AMGA reports. Continue Reading
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17 Jun 2020
Advocate Aurora, Beaumont Health Explore Healthcare Merger Deal
The health systems signed a non-binding letter of intent to discuss a potential healthcare merger deal that would create a system spanning across Michigan, Wisconsin, and Illinois. Continue Reading
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17 Jun 2020
3 Keys to Healthcare Staffing at NYC H+H During COVID-19
Flexibility, communication, and technology enabled the large public health system to ensure appropriate healthcare staffing in what was once considered the epicenter of COVID-19 in the US. Continue Reading
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15 Jun 2020
Mending Payer Relations Smooths Revenue Cycle at Northwestern Med
Engaging in more productive conversations with payers helped Northwestern Medicine exceed net patient revenue goals and address its more pressing revenue cycle challenges, including COVID-19. Continue Reading
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15 Jun 2020
COVID-19 Has Execs Seeing Healthcare M&A Plans with Fresh Eyes
While some healthcare merger and acquisition plans have fallen apart because of COVID-19, some providers are rethinking potential partnerships to survive the economic fallout of the pandemic. Continue Reading
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15 Jun 2020
Strategies for Re-engaging with the Patient Financial Experience
Patient financial experience took a hit during the COVID-19 crisis, but technology that removes barriers to service and provides omnichannel support can help reengage consumers. Continue Reading
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12 Jun 2020
ACOs Lean More on Physician Assistants, Non-Physician Providers
The average number of physician assistants and other non-physician providers in ACOs rose from 47 to 245 clinicians from 2013-18, a larger increase compared to PCPs and specialists, study finds. Continue Reading
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11 Jun 2020
Key Considerations for Reopening Healthcare Facilities Amid COVID-19
Safety precautions, telehealth, testing, data analytics, and compliance should be core to a healthcare facility’s strategy for resuming in-person case during the next phase of the pandemic. Continue Reading
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10 Jun 2020
Healthcare Workforce Rose 312K Despite Ongoing Hospital Job Losses
The healthcare workforce started to rebound in May 2020 even though hospitals lost nearly 27K jobs in a month, the Bureau of Labor Statistics shows. Continue Reading
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09 Jun 2020
How Nebraska Medicine Avoided Furloughs During COVID-19
As providers make drastic spending cuts due to COVID-19, Nebraska Medicine is leveraging labor and productivity data to redeploy staff and prepare for future challenges to its operations. Continue Reading
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08 Jun 2020
Healthcare CFOs Looking to Technology to Boost Waning Margins
Healthcare CFOs overwhelmingly agree that COVID-19 is creating a need to reduce spending, but few anticipate cutting their financial IT budgets in 2020. Continue Reading
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08 Jun 2020
How Purpose-Built RCM Systems for Labs Boost Enterprise ROI
Investing in purpose-built revenue cycle management systems transforms labs from cost to profit centers, drawing in revenue for the entire organization. Continue Reading
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03 Jun 2020
Cerner Sells Revenue Cycle Management Outsourcing Arm
Revenue cycle management company R1 RCM will acquire Cerner RevWorks following lackluster customer reviews of the outsourcing product. Continue Reading
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02 Jun 2020
For-Profit Rural Hospitals Face High Levels of Financial Distress
The median overall profit margin for for-profit rural hospitals declined from 2011-2017, while non-profits saw less significant declines and even a boost among CAHs, a new study shows. Continue Reading
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27 May 2020
Volume Declines Drive Hospital Operating Margins Down 282% in April
April was the worst month ever for hospital finances, as COVID-19 continued to impact volumes, revenue, and ultimately hospital operating margins, Kaufman Hall reports. Continue Reading
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26 May 2020
Provider Compensation Increased in 2019 as Docs Saw More Patients
Provider compensation rose across the board in 2019 as providers experienced increases of up to 10% in productivity, but COVID-19 could bring these numbers down in 2020, MGMA reports. Continue Reading
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21 May 2020
22% of Physician Assistants Furloughed, Others Redeployed
The physician assistant workforce is undergoing massive change during the COVID-19 crisis, with many being put on the sidelines while others are being rapidly redeployed to other settings. Continue Reading
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21 May 2020
How COVID-19 Has Impacted Top Clinical Service Lines at Hospitals
COVID-19 continues to damage inpatient and outpatient volumes, with certain clinical service lines being hit harder than others. Continue Reading
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20 May 2020
How University Hospitals Is Resuming Elective Surgeries
Hospitals have stopped elective surgeries due to COVID-19, but teamwork, data, and testing are helping University Hospitals meet pent-up demand now that the peak has passed in Ohio. Continue Reading
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19 May 2020
Nearly a Fifth of Primary Care Practices Are Temporarily Closed
Meanwhile, a majority of primary care practices have reduced working hours for all staffing types, with 42% reporting layoffs and furloughs of clinicians and staff, a new survey shows. Continue Reading
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18 May 2020
3 Revenue Cycle Management Strategies for EDs in a Time of Crisis
Financial indicators, staffing, and leadership are three key factors emergency departments should prioritize for effective revenue cycle management during the COVID-19 crisis. Continue Reading
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13 May 2020
Should Physician Practices Return Paycheck Protection Program Loans?
Many physician practices are considering returning Paycheck Protection Program loans by the May 14 deadline, but new guidance may change their minds. Continue Reading
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12 May 2020
Adapting Patient-Friendly Medical Billing to a COVID-19 World
Monument Health in South Dakota is adapting to a new definition of patient-friendly medical billing as COVID-19 transforms patient needs and their ability pay for healthcare. Continue Reading
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11 May 2020
Hospital Visits Reached Record Low in April as COVID-19 Spread
Hospital visits declined 33-62% from March to mid-April but started to rise as elective procedures resumed by the end of the month, according to a new report. Continue Reading
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11 May 2020
Redefining Patient Collections in the Wake of the COVID-19 Crisis
The COVID-19 crisis is transforming patient collections, requiring providers to deliver a transparent, compassionate financial experience as patients weigh coming back and demand ramps back up. Continue Reading
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08 May 2020
AHA: Hospitals Losing $50.7B a Month Fighting the Coronavirus
Hospitals will lose a total of $202.6B between March and June 2020, as facilities incur additional costs for responding to the COVID-19 crisis, AHA reports. Continue Reading
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07 May 2020
Hoag Seeks Independence from Providence After Its Hospital Merger
The two-hospital system in California is suing to end its affiliation with Providence Health years after the system closed a hospital merger deal with St. Joseph Health. Continue Reading
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Feature
06 May 2020
How COVID-19 Imperiled Physician Practices, And How to Save Them
Physician practice revenue has been cut in half during the early part of the COVID-19 pandemic. Could telehealth and payment reform save the independent physician? Continue Reading
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05 May 2020
Hospital Revenue Falling $1.4B A Day As Patient Volume Drops
Patient volumes have been cut in half despite expected surges in COVID-19 cases, resulting in drastic hospital revenue losses since the start of the pandemic in the US. Continue Reading
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04 May 2020
Acquisitions of Ambulatory RCM Vendors Barely Impacted Performance
6 of 8 ambulatory revenue cycle management vendors analyzed by KLAS have been acquired in the past few years, but the transactions have not diminished client experience. Continue Reading
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04 May 2020
Leveraging Payer, Client Behavior Data to Maximize Lab Revenue
Leveraging payer and client behavior data gives labs the holistic view they need to maximize lab revenue and prevent reimbursement problems down the road. Continue Reading
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30 Apr 2020
Hospital, Outpatient Visits Fell Up to 60% During COVID-19 Crisis
New research shows that hospital and outpatient visits have taken a significant hit as providers canceled elective procedures and patients stayed home during the first month of the COVID-19 crisis. Continue Reading
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30 Apr 2020
Patient Collections Takes Over a Month for Most Providers
Manual processes and a lack of alignment with consumer expectations may be creating patient collections delays for a majority of providers, a new survey suggests. Continue Reading
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29 Apr 2020
Beaumont, Summa Health Delay Hospital Merger Until After COVID-19
The health systems are focusing on combatting COVID-19 and have decided to postpone a planned hospital merger deal until after the crisis. Continue Reading
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29 Apr 2020
Medical Groups Slam CMS For Suspending Advance Payment Program
Medical groups have relied on the Advance Payment Program to offset cash flow issues stemming from the COVID-19 crisis, AMGA argued. Continue Reading
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28 Apr 2020
21% of Physicians Furloughed, Had Pay Cut During COVID-19 Crisis
About a third of physicians also plan to change practice settings or stop providing patient care as a result of the COVID-19 crisis, a recent survey found. Continue Reading
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28 Apr 2020
Hospital Operating Margins Dropped As COVID-19 Started to Spread
Hospital operating margins dropped by 150% year-over-year as patient volumes and revenue fell in March 2020, the start of the COVID-19 pandemic in the US. Continue Reading
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23 Apr 2020
Advance Practice Providers Drive Practice Efficiency in Oncology
Sixty percent of oncology physicians said employing advanced practice providers improved practice efficiency, a key performance indicator for the revenue cycle. Continue Reading
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22 Apr 2020
20% of Primary Care Practices Anticipate Closing in a Month
Primary care practices are at serious risk of closing as patient volume and revenue continue to sharply decline during the COVID-19 pandemic. Continue Reading
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20 Apr 2020
Identifying a Patient Collections Solution for COVID-19 and Beyond
Healthcare organizations can adapt to the “new normal” with an easy-to-install patient collections solution that engages all patients with interest-free, long-term payment plans. Continue Reading
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16 Apr 2020
AMA Shares Wishlist for Physician Practice Relief During COVID-19
Medicare and Medicaid payment adjustments, more small business loan funding, and greater telehealth coverage are among the measures AMA and others want for Phase 4 of COVID-19 help. Continue Reading
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15 Apr 2020
Physician Practice Revenue Cut in Half Due to COVID-19 Crisis
On average, physician practices revenue declined 55 percent since the beginning of the COVID-19 crisis, while patient volume fell 60%, MGMA reports. Continue Reading
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Feature
10 Apr 2020
How Artificial Intelligence Is Optimizing Revenue Cycle Management
Artificial intelligence is addressing some of the biggest pain points in revenue cycle management, leading to increased revenue capture and integrity for early adopters of the technology. Continue Reading
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09 Apr 2020
25% of Rural Hospitals at Risk of Closing as Patients Go Elsewhere
Over three-quarters of patients in select rural communities traveled for care, leaving more rural hospitals on the brink of closing, Guidehouse reports. Continue Reading
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09 Apr 2020
AMGA Seeks Payroll Relief for Medical Groups Impacted by COVID-19
The association called on the Treasury Department and Small Business Administration to allow medical groups to access forgivable loans to cover payroll during the COVID-19 pandemic. Continue Reading
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07 Apr 2020
COVID-19 Testing Shortage Hinders Hospital Efforts to Combat Virus
The COVID-19 testing shortage is delaying the diagnosis and treatment of patients and exacerbating other issues, such as PPE shortages and capacity limitations, OIG reported. Continue Reading
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07 Apr 2020
Hospital Revenues Rose, Margins Fell Before COVID-19 Outbreak
Most hospital revenues and volume metrics were up, while margins fell slightly in February 2020, which was the last month of business as usual for most organizations, Kaufman Hall reports. Continue Reading
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06 Apr 2020
A 21st-Century Response to the Patient Collections Challenge
Today’s patient collections challenges call for a smarter approach. Rich data analytics and automation can help health systems proactively identify coverage and optimize collections for reduced revenue loss and a better patient financial experience. Continue Reading
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02 Apr 2020
Hospitals Furloughing Staff, Altering Physician Pay Due to COVID-19
Reports of hospitals reducing their workforce and reducing physician compensation continue to emerge as organizations attempt to overcome financial difficulties caused by COVID-19. Continue Reading
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01 Apr 2020
Group Purchasing Reduces Healthcare Supply Chain Costs by 13%
Group purchasing organizations also helped increase competition, transparency, and even emergency preparedness for events like COVID-19, a new report shows. Continue Reading
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01 Apr 2020
80% of CFOs Expect Revenue, Profit Declines Due to COVID-19
More CFOs anticipate COVID-19 to have a negative impact on revenue and profits as they realize the effects of the outbreak will not dissipate quickly. Continue Reading
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31 Mar 2020
How Much Will the COVID-19 Pandemic Cost Hospitals?
The US healthcare system is still in the thick of the COVID-19 pandemic, but new estimates paint a dire picture of the system’s financial future. Continue Reading
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30 Mar 2020
Clean Claim, Write-Off Metrics Key to Diagnostic Provider Success
Tracking key metrics like clean claim and write-off rates is key to laboratories and diagnostic providers maximizing revenue. Continue Reading
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26 Mar 2020
Playing Defense Key to Overcoming Fiscal Challenges of COVID-19
Hospitals should identify liquidity and other opportunities to lower costs to remain financially healthy during the coronavirus outbreak, a financial expert says. Continue Reading
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25 Mar 2020
Primary Care Practices Overwhelmed by COVID-19, PPE Shortages
85% of primary care practices commenting on a survey are experiencing PPE shortages as COVID-19 continues to significantly impact their practices. Continue Reading
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25 Mar 2020
National Healthcare Spending to Climb to 19.7% of GDP by 2028
New estimates from the Office of the Actuary at CMS show that national healthcare spending is slated to grow by 5.4% annually from 2019-28 but those projections do not account for COVID-19. Continue Reading
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20 Mar 2020
CommonSpirit Health, Others Suspend Patient Billing for COVID-19
The large health system is the latest to announce the temporary suspension of certain patient billing during the COVID-19 outbreak. Continue Reading
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19 Mar 2020
Hospitals Look to Reduce Corporate Services Spending
75% of hospital and health system executives believe they can reduce corporate services spending, with many targeting revenue cycle management for reductions. Continue Reading
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17 Mar 2020
Hospitals Delay, Shift Surgeries to Outpatient Due to COVID-19
Hospitals are freeing up capacity to prepare for COVID-19 patients by postponing elective procedures and shifting some to ASCs and other outpatient settings. Continue Reading
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12 Mar 2020
Benefit of Private Equity in Healthcare? Lessons from Nursing Homes
Private equity in healthcare is increasing, but a new paper exploring its role in nursing homes shows a negative impact on quality of care. Continue Reading
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12 Mar 2020
Long-Term Care Demand to Double Despite Workforce Constraints
A new report portrays a dismal future for the long-term care workforce as demand continues to grow, surpassing supply. Continue Reading
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10 Mar 2020
How COVID-19 Is Impacting the Healthcare Revenue Cycle
COVID-19 is creating unique healthcare revenue cycle challenges around billing and coding, patient financial responsibility, and resource allocation. Continue Reading
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09 Mar 2020
Gain New Insights With Analytics, AI to Accelerate RCM Workflow
AI, machine learning, and other business intelligence analytics tools can help providers streamline RCM workflows and save millions on costly, manual interventions. Continue Reading
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05 Mar 2020
Hospital Revenue, Margins Improved in 2019 Despite Rising Expenses
Data from Kaufman Hall shows that hospital revenue made modest gains in the face of rising expenses, resulting in improved margin performance in 2019. Continue Reading
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04 Mar 2020
Nurse Practitioner Workforce Hits Record High of 290K
The nurse practitioner workforce and their compensation continue to grow as organizations increasingly rely on team-based care. Continue Reading
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03 Mar 2020
FTC, PA Challenging Proposed Hospital Merger in Philadelphia
The entities are seeking to block the proposed hospital merger between Jefferson Health and Albert Einstein Healthcare Network over competition concerns. Continue Reading
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26 Feb 2020
1% of People Account for 22% of Total Healthcare Spending
Additionally, the top 5% of the population accounted for over half of total healthcare spending in 2017, according to a new statistical brief from AHRQ. Continue Reading
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25 Feb 2020
Private Equity Firms Increasingly Buying Physician Practices
New research shows that acquisitions of physician practices by private equity firms more than doubled over a 3-year period. Continue Reading
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24 Feb 2020
Overcoming Hospital Laboratory Revenue Cycle, Interoperability Issues
Improving hospital laboratory revenue cycle management through data analytics and cloud-based technology can transform the area from a cost to a revenue center. Continue Reading
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18 Feb 2020
Top-Earning Non-Profit Hospitals Offer Less Charity Care
A new study shows that non-profit hospitals earning the most income provided significantly lower levels of charity care compared to those earning the least. Continue Reading
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13 Feb 2020
How Much Are Health Systems Spending on Social Determinants?
A study of investment announcements found that 57 health systems invested at least $2.5 billion in social determinants of health over a two-year period. Continue Reading
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12 Feb 2020
AdventHealth Swaps Out Cerner Revenue Cycle Management for Epic
The health system announced plans to transition from its Cerner revenue cycle management and EHR systems following rumors of revenue cycle quality issues. Continue Reading
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11 Feb 2020
CAQH CORE Approves 2-Day Limit for Prior Authorization Response
The two-day rule will accelerate the prior authorization process to improve patient care delays and promote efficiency in health systems, the group says. Continue Reading
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05 Feb 2020
Nurse Practitioner Workforce More Than Doubled, Study Finds
The nurse practitioner workforce increased from approximately 91,000 in 2010 to 190,000 in 2017, but it could spell trouble for hospital staffing models. Continue Reading
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04 Feb 2020
CFOs Want To Cut Costs But Don’t Have Data, Resources To Do It
Identifying and managing cost-reduction initiatives is the top priority for healthcare CFOs, but resource constraints and insufficient data are preventing efforts, a survey shows. Continue Reading
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03 Feb 2020
Docs Satisfied with Epic, Warming to Cerner Practice Management
KLAS named Epic the top overall software suite in 2020, but the Cerner Practice Management product significantly improved, especially for small practices. Continue Reading
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03 Feb 2020
UMass Memorial, Harrington Healthcare Reveal Hospital Merger Plan
Other recent hospital merger and acquisition activity included the close of the OSF Healthcare-Little Company deal, the sale of ProMedica hospital, and the opening of a new emergency facility for Baptist Health Hospital. Continue Reading
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31 Jan 2020
Hospital Drug Spending to Increase 3.59%, Vizient Estimates
Hospital drug spending is slated to increase from July 1, 2020, to June 30, 2021, due to expensive biologic therapies, oncology drugs, disease-modifying antirheumatic drugs, and immunomodulators. Continue Reading
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29 Jan 2020
Four South Chicago Hospitals Announce $1.1B Hospital Merger Deal
The proposed hospital merger deal will tackle health inequities in local Chicago communities and transform care delivery for patients, officials say. Continue Reading
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28 Jan 2020
Hospital Merger and Acquisition Grew as Physicians Took a Step Back
Hospital merger and acquisition activity increased 19% in 2019 as physician medical group volume fell by 14%, a new report shows. Continue Reading
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27 Jan 2020
New Quality Measure to Evaluate Psychiatric Hospital Readmissions
The new quality measure assesses hospital readmission risk factors following discharges to uncover differences in care across psychiatric hospitals. Continue Reading
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23 Jan 2020
Hospital Price Transparency Services Scratch Surface of Spending
70 shoppable services identified in CMS’ recent hospital price transparency rule accounted for just 12 percent of employer-sponsored healthcare spending, HCCI reports. Continue Reading
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23 Jan 2020
Feds Go After Medical Debt Collection for Military Hospitals
A new report spotlights aggressive medical debt collection tactics used by the federal government to cover the costs of civilian care at military hospitals. Continue Reading
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22 Jan 2020
Hospital Merger and Acquisition Activity Strong and Steady in 2019
Hospital merger and acquisition activity hovered around recent historical highs as consumerism and disruption continued to take hold, Kaufman Hall reports. Continue Reading
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13 Jan 2020
Targeting Superutilizers Does Not Impact Hospital Readmissions
A new study shows that patients in a “hotspotting” program had similar 180-day hospital readmission rates compared to similar patients not receiving additional services. Continue Reading
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13 Jan 2020
EHR Interoperability Key to Revenue Cycle Management Success
EHR interoperability is needed to bring together clinical and financial data for revenue cycle management success now and in a patient-centered future. Continue Reading
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08 Jan 2020
DOJ Accuses Community Health Network of Medicare Fraud
The department joined a whistleblower lawsuit alleging that Community Health Network committed Medicare fraud by rewarding physician referrals with compensation above fair market value. Continue Reading
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08 Jan 2020
How Nebraska Medicine Boosted Revenue Cycle Efficiency
Automating key financial processes was key to allocating resources and improving revenue cycle efficiency at the large academic health system. Continue Reading
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News
06 Jan 2020
3 Ways to Improve Patient Financial Experience and the Bottom Line
Providers are relying more on their patients for revenue generation and collection, making the patient financial experience a top priority for business leaders. Continue Reading
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03 Jan 2020
5 Hospital Merger and Acquisition Moves Kicking Off 2020
Several major deals are jumpstarting hospital merger and acquisition activity in 2020, including more CHS divestitures, acquisitions of urgent care centers, and the sale of a residency program. Continue Reading