AI coding at UMass Memorial tempers staffing shortage
UMass Memorial Medical Center’s radiology department has been able to sidestep a lack of bill coding professionals by adopting AI in the medical center’s coding for radiology. “It’s really hard to get certified coders these days,” said Barbara Scully, associate vice president, physician billing with UMass Memorial, which is located in Worcester, Massachusetts. “It’s one…
5 key strategies for a successful mid-cycle
Today’s mid-cycle teams face mounting pressure. Oversight is tightening, payer policies are shifting rapidly and margins continue to shrink. This phase is no longer a simple pass-through, it’s a vital operational checkpoint that demands both strategic leadership and attention to detail. Hospitals that implement structure and prioritize accuracy tend to stay ahead. Those that don’t…
Fortifying revenue management: The critical role of health information management in cybersecurity preparedness
A hospital’s health information management (HIM) team oversees the flow of patient care documentation in healthcare organizations, supporting accuracy, accessibility and security. In the revenue cycle, HIM maintains financial integrity by managing patient data, ensuring proper coding and documentation for billing and verifying clinical data for compliance and reimbursement. HIM also plays an active role…
For-profit health systems turn to AI and automation to manage payer denials
Some for-profit health systems are increasingly looking to AI and other automation tools to tackle the worsening problem of payer denial management, as 73% of providers have seen claims denials increase.
Hospital financial and revenue cycle benchmarks paint a complicated picture heading into the new year
The tail end of 2024 has brought promising news regarding hospital financial metrics, even as revenue cycle indicators suggest continuing strain. Margin data are showing moderate improvement, and one of the three credit-rating agencies has upgraded its 2025 sector outlook for not-for-profit (NFP) hospitals and health systems. Fitch Ratings announced this week it was revising…
Common coding challenges hospitals face and how to fix them
Managing revenue and profitability has become increasingly difficult for hospitals, leading many to take drastic cost-cutting measures. However, there are less painful options, including reevaluating and revamping medical coding processes. Managing revenue and profitability has become increasingly difficult for hospitals, leading many to take drastic cost-cutting measures. However, there are less painful options, including reevaluating…
The patient as the new payer: 5 opportunities to improve the patient financial experience
Patient collections have become an increasingly difficult challenge for hospitals due primarily to a shift in payer mix. Because of rising deductibles and increased patient responsibility, the percentage of healthcare provider revenue collected directly from patients increased to more than 30% from less than 10% over ten years, according to an article from HITLeaders. Faced…
4 tips for simplifying prior authorizations
Healthcare spending in the U.S. has reached what many consider to be unsustainable levels. While spending in other developed nations averaged 8.8% of GDP in 2019, it was nearly double that in the U.S. at 16.8%. One of the major contributors to this spending is administrative waste, which accounts for up to 30% of our…
How to automate revenue cycle operations to improve revenue and reduce resource dependency
Even with an increased focus on automation in the industry, too many revenue cycle operational processes remain highly manual and resource intensive. This is especially true for mid-cycle processes. Manual data entry, such as coding, leaves significant room for error and takes longer to complete, leading to slower reimbursement and ultimately impacting the bottom line. Automation…
How to protect your revenue cycle on the road to price transparency compliance
While the CMS hospital price transparency rule has been in place for more than a year now, the vast majority of hospitals are still noncompliant.