Category: Blog

Union Lowers Medical Bills With Direct Negotiations

As companies shift more and more healthcare costs to their employees, the doormen, office cleaners, cafeteria staff and other members of the union 32BJ SEIU remain among the lucky few who pay no premiums and have no deductibles as part of their benefit plan. Keeping it that way has been no easy task. With each new collective-bargaining agreement, the […]
Learn More
revenue cycle transformation

Top 3 Challenges To Revenue Cycle Transformation

Hospitals and health systems are exploring ways to revenue cycle transformation processes to offset financial pressures. However, shifting to a new business model for revenue cycle management can be challenging. The hospital revenue cycle has become increasingly complex in recent years for several reasons, including the shift away from fee-for-service medicine, the adoption of advanced […]
Learn More
HCPCS Coding

CMS Announces HCPCS Coding, Coverage And Payment Initiatives To Improve Patient Access To New Technologies

On May 2, the Centers for Medicare and Medicaid Services (CMS or the Agency) announced in a press release that it will be changing how frequently the Agency reviews applications for new and revised Level II codes under the Healthcare Common Procedure Coding System (HCPCS). Specifically, CMS stated that the Agency “is moving to a process with […]
Learn More
Medicare Advantage for Dual Eligibility

Medicare Advantage Dual Eligible’s Have Fewer ER Visits Than Those Under FFS

Dual eligible Medicare Advantage beneficiaries had 42.1% less emergency room visits than their fee-for-service counterparts. The cost of care and rate of hospitalizations for dual eligible Medicare Advantage (MA) beneficiaries was considerably lower than dual eligibles under fee-for-service (FFS), according to an Avalere Health study released Tuesday evening. Dual eligible Medicare Advantage (MA) populations averaged healthcare […]
Learn More
Prior Authorization Process

Prior Authorization Process Moves Closer To Automation

CAQH CORE, a healthcare industry-led operating standards group, has announced new rules that move the healthcare industry closer to fully automating the prior authorization process. “Not only do the operating rules represent a foundational step forward in improving the prior authorization process, they also signal broad industry commitment to adopting tangible solutions to reduce administrative burdens,” said […]
Learn More
Surprise Billing Solution

Providers, Insurers Parse What They Could Support – And What They Won’t – In Surprise Billing Solution

While both providers and insurers have found it difficult to agree on a solution to surprise billing, experts on both sides expressed support Tuesday for banning the practice – thereby forcing insurers and providers to work out payment disputes among themselves—when patients have gone to in-network hospitals. The approach, which has been tried in Oregon, […]
Learn More
Surprise Medical Bills

Hospitals, Payers Must be Held Accountable For Surprise Medical Bills

President Donald Trump said it’s time for Congress to pass a law that stops hospitals and insurance companies from hitting patients with surprise medical bills. “We’re going to hold insurance companies and hospitals accountable,” Trump said during a news briefing Thursday. A bipartisan group of senators have been working on a bill addressing the issue, with the plan to […]
Learn More
x