Category: Revenue Cycle Management

Hospital Price Transparency

Key Opportunities For Hospitals To Boost Margins In The Era Of Price Transparency

About 60 million Americans live in rural areas and depend on local hospitals for care. In 2019, a record 18 rural hospitals closed, bringing the total closures since 2010 to 124, according to the Cecil G. Sheps Center for Health Services Research. With almost 700 more rural hospitals at risk of shutting, the need for strategies to boost […]
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Healthcare Price Transparency Rule

New Healthcare Price Transparency Rule – The Best, Worst, and Most Realistic Case Scenarios

The American Hospital Association has filed a lawsuit to block the rule. On Nov. 15, 2019, the Trump Administration proposed a new healthcare price transparency rule that would basically require hospitals to explain how much a medical service would cost before a patient receives treatment. This rule is due to become effective in January 2021. The […]
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Medicare Advantage Plans

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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2020 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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Prior Authorizations

9 Ways To Ease The Prior Authorization Burden

Prior authorizations, or prior approvals, are strategies that payers use to control costs and ensure their members only receive medically necessary care. The cost-control process requires providers to acquire advance approval from payers before delivering specific services or items for a patient. Payers are increasingly using prior authorizations to lower their costs and improve care […]
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AI and ML in Healthcare

Three Ways AI And ML Are Making A Difference In Healthcare

Much of the buzz you hear about artificial intelligence (AI) or machine learning (ML) in healthcare is about its clinical applications, whether assisting doctors with diagnoses or customizing cancer treatment plans. But healthcare is a big industry, and the financial and administrative sides are immense and complex. The reality is AI and ML in healthcare are powerful tools […]
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Hospital Reimbursement

Trump Budget Eyes More Site-Neutral, Hospital Reimbursement Cuts

President Trump’s proposed FY 2021 budget includes hospital reimbursement cuts, including more site-neutral payments, as well as a unified post-acute care payment system. President Trump’s proposed budget for the 2021 fiscal year (FY) is stirring up controversy over massive cuts to Medicare and Medicaid spending and proposals to implement work requirements and block grants in Medicaid. But […]
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