Category: Revenue Cycle Management

Common Revenue Cycle Issues

3 Twists on Common Revenue Cycle Issues

Denials, automation, and surprise billing are perennially tricky & common revenue cycle issues, but new twists on those topics add an extra layer of complexity. When it comes to revenue cycle management, a handful of common revenue cycle issues are nearly always a struggle, year after year. For instance, denials, automation, and surprise billing are […]
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Impacting the Healthcare Revenue Cycle

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. As entire nations encourage their populations to stay inside to avoid COVID-19, healthcare providers are more active than ever in response to the outbreak of the novel coronavirus. This activity is having a significant impact on the […]
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Medicare Advantage and the Medicare Drug Plan

New Directions for Medicare Advantage and the Medicare Drug Plan in 2021

The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would update Medicare Advantage plan (MA, or Part C) and the Medicare prescription drug benefit (Part D) program. In years past, CMS has also issued a “call letter,” not subject to the regulatory process, to provide additional information for plans to use […]
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MIPS Changes

What You Need to Know About 2020 MIPS Changes

In November 2019, CMS published the 2020 Quality Payment Program Final Rule (the “2020 MIPS Final Rule Changes”). Below is a summary of some of the most notable changes to the Merit-Based Incentive Payment Program (MIPS). For a complete list of changes, please review the 2020 MIPS Final Rule or CMS’ Quality Payment Program Resource […]
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The ROI of RPA and AI in The Revenue Cycle

The ROI of RPA and AI in The Revenue Cycle

HBI data reveals that the rate of hospitals or health systems that have implemented artificial intelligence for any revenue cycle function has not widely increased over the past year, but automation in healthcare has shown some forward movement in comparison. Based on the conversations revenue cycle analysts have conducted with HBI members over the past […]
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New Rules from CMS

More New Rules from CMS for FY 2020

Among the proposed new rules is one intended to clarify the contentious “Stark Law” On Oct. 9, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule to modernize and clarify the regulations that interpret the Medicare physician self-referral law (often called the “Stark Law”). The law prohibits physicians from making referrals for […]
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AI Can Help Health Plans Become Member-Centric

How AI Can Help Health Plans Become Member-Centric

Improving the customer experience is no longer an idea that’s relegated to the retail or hospitality industries. Now, the idea has gained traction across many industries, including healthcare. For health plans, improving the customer experience and providing member-centric care helps drive member acquisition and retention and improve reimbursement (via a better STARS rating). With so […]
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