Tag: Healthcare providers

Top 3 Challenges To 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 […]
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Prior Authorization Process Moves Closer To Automation

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 […]
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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, […]
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Hospitals, Payers Must be Held Accountable For 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 […]
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Customize Patient Financial Encounters For Revenue Cycle Success

Customize Patient Financial Encounters For Revenue Cycle Success

Healthcare is a top priority for American voters and there aren’t dramatic differences by ideology, according to a new survey. Adopted from the marketing industry, customer segmentation allows health systems to further customize the patient financial experience and help them get paid. Key Takeaways Tailor billing strategies and patient payment options to a financial situation […]
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Providers Exempt

Are Providers Exempt From Information Blocking Backlash?

Keen on giving Americans in federally-funded programs more control over their healthcare, the U.S. Department of Health and Human Services (HHS) has been working closely with past and present administrations to establish regulations governing electronic health information (EHI). On March 4, the Office of the National Coordinator for Health Information Technology (ONC) published a proposed […]
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CMS To Revamp Coding For New Medical Technology

CMS To Revamp Coding For New Medical Technology

Dive Brief CMS Administrator Seema Verma announced Thursday the agency will overhaul coding regulations that she argues have hindered beneficiary access to new medical technology. Medical device companies will now be able to apply for a new permanent Healthcare Common Procedure Coding System (HCPCS) code twice a year, instead of annually. CMS also recently eliminated […]
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How to Prevent and Manage Claim Denials

How to Prevent and Manage Claim Denials

For many healthcare providers, claim denials are a frustrating cost of doing business. Each year, around 5-10% of medical billing claims are rejected (possibly more). With each claim costing around $25 to rework, providers lose billions in eroded revenue and productivity. Any revenue leakage is bad enough, but the shift towards value-based care means tighter revenue cycle management […]
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