For millions of Americans relying on Medicare, the specter of high out-of-pocket healthcare costs looms large. Unexpected illnesses, chronic conditions, and even routine medical needs can quickly erode savings and create significant financial strain. The idea of a Medicare out-of-pocket spending cap has long been a topic of discussion, promising a shield against catastrophic expenses. […]
Upcoding in Medical Billing, the act of billing for a higher level of service than was actually provided in medical billing, is unfortunately not uncommon. While it may seem like a harmless way to boost revenue, the consequences are far-reaching and detrimental to both patients and the healthcare system as a whole. Upcoding in Medical […]
The United States grapples with a healthcare affordability crisis, anticipating a 6.5 percent surge in costs due to inflation next year. Amidst concerns over escalating medical expenses, the deeper roots of these inflated prices often evade attention. Deficient government policies, notably Medicare reimbursement policies, contribute to consolidating the healthcare sector, ultimately driving up costs that […]
Anticipate further transformations ahead, with 2024 poised to introduce substantial shifts within the healthcare sector. This period of change will be marked by the rapid proliferation of artificial intelligence, intricately woven into the entirety of the healthcare framework, presenting opportunities to enhance healthcare delivery and elevate patient outcomes. Consider this scenario: Picture yourself as a […]
Last week, during the onset of the summer recess, the House Ways and Means Committee introduced a healthcare reform bill. Regrettably, this legislation lacks the same potential impact as the competing bill presented by the House Energy and Commerce Committee, known as the Patient Act. What are the shortcomings of this new bill? It falls […]
Having been on the receiving end of audits, and also having been an individual who has conducted them, I know the mindset from both sides of this equation. The one element to this equation that has changed over time is the increase in payer denials: those that are now clinical- and coding-focused, often resulting in […]
CMS attributes the increases in part to rising prices and utilization across the healthcare system, as well as Aduhelm. The standard monthly premium for Medicare Part B enrollees will be $170.10 for 2022, an increase of $21.60 from $148.50 in 2021. This represents a 14.5% increase. The annual deductible for all Medicare Part B beneficiaries […]
The survey found that median provider salary and benefits expense as a percent of net revenue increased from 72.1 percent to 84.9 percent, which is the outcome of provider compensation being protected during the COVID-19 pandemic combined with decreased productivity. In addition, the survey showed a net revenue decrease from 24.2 percent to 22.8 percent […]
To reduce care variation, SSM and Optum will use clinical technologies, advanced analytic and data-driven insights at the point of care. Certain SSM Health revenue cycle staff and hospital care management will become employees of Optum. They will continue to work in their current locations across Illinois, Missouri, Oklahoma and Wisconsin. WHY THIS MATTERS As […]
In its simplest form, revenue cycle management is the process healthcare providers use to ask for, track, and collect revenue for services rendered to patients. But as medical billing gets more complex, revenue cycle management is expanding beyond the business office. At Jackson Hospital in Montgomery, Alabama, for example, revenue cycle management also includes […]









