Category: Revenue Cycle Management

Denial prevention

Denial Prevention: A Strategic Imperative for Revenue Cycle Management

Denial prevention has become a paramount focus within healthcare revenue cycles, as the financial toll of claim denials continues to rise. The increasing use of artificial intelligence (AI) by payers has further exacerbated this challenge. To mitigate these losses, a strategic shift is necessary, transitioning from a reactive approach of managing denials post-occurrence to a […]
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outsourcing Revenue Cycle Management

Outsourcing Revenue Cycle Management Services: A Solution for Independent Physicians

Independent physicians, while passionate about patient care, often find themselves entangled in the intricate web of financial management. This has become increasingly challenging with the shift towards value-based care and the growing complexity of payer contracts. Outsourcing Revenue cycle management (RCM), the process of managing financial operations from appointment scheduling to claim settlement, has emerged […]
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Financial impact of VBC

Navigating the Financial Impact of Value-Based Care (VBC)

The financial impact of VBC is profound, necessitating adjustments in how providers approach and manage their financial operations to align with this new model of care. The healthcare industry is shifting towards value-based care (VBC), a model that prioritizes high-quality care while aiming to lower costs. In contrast to the traditional fee-for-service model, value-based care […]
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Value-Based Care challenges

Value-Based Care: Navigating Challenges and Opportunities in Revenue Cycle Management

RCM and Value-Based Care Challenges and Opportunities: Healthcare is a dynamic field constantly evolving to improve patient and staff experiences. As the industry transforms, it’s crucial to understand both the potential benefits and drawbacks of these changes. One area experiencing significant evolution is Revenue Cycle Management (RCM). The shift towards value-based care models is a […]
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Coverage Denials

Survey Reveals Key Issues with Challenging Surprise Medical Bills and Coverage Denials

A new study by the health care system reveals a significant gap in consumer healthcare rights. Despite attempts to curb surprise medical bills, a large portion of insured Americans are still receiving unexpected charges. Adding to this problem is the high rate of coverage denials, leaving patients with substantial out-of-pocket costs and causing financial hardship […]
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impact urology practices

Medicare Physician Fee Schedule 2025: Urology Practice Impact

urology practices: The Centers for Medicare & Medicaid Services (CMS) unveiled its proposed Medicare Physician Fee Schedule for 2025 on July 10, 2024. This outlines potential payment adjustments and policy changes that would take effect starting January 1, 2025. A public comment period will follow, during which CMS will gather feedback to inform the final […]
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Generative AI

GenAI Revolutionizing Healthcare: Transforming Revenue Cycle Management

Generative AI is revolutionizing healthcare: Recent breakthroughs have seen these models excel in medical exams, complex diagnoses, and even pandemic response strategies. Advanced language models like GPT-4, Google’s Bard, and specialized healthcare models are now capable of handling intricate tasks that can dramatically improve clinical decision-making and administrative efficiency. The immense potential of Generative AI […]
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physician practice RCM

RCM in Physician Practices: Key Steps Revealed by AMA

Physician RCM: This guide dives into key areas physician private practices can target to strengthen their revenue cycle management (RCM), as outlined by the American Medical Association (AMA) in recent News. By optimizing these eight steps, practices can ensure timely and accurate reimbursement for services provided. 1. Patient Registration: Accuracy First The foundation of a […]
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Why Healthcare Providers Need Medical Claim Clearinghouses

Medical claim clearinghouses enhance the efficiency of claim submissions for healthcare providers, thereby reducing costs and improving payment accuracy. Each year, healthcare payers and providers exchange billions of claims to finalize patient encounters, a number that continues to rise. As claim volumes increase annually (except for a dip in 2021 due to the COVID-19 pandemic), […]
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Benefits of Remote Patient Monitoring (RPM)

The COVID-19 pandemic highlighted the need for alternative healthcare delivery methods. Remote patient monitoring (RPM) emerged as a valuable complement to telehealth, allowing doctors to remotely monitor patients’ health data in real-time. How Remote patient monitoring Works RPM utilizes various devices to track vital signs like blood pressure, heart rate, and blood sugar. It can […]
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