Value-based care adoption grows, but challenges remain
In 2006, two renowned researchers introduced “The Value Equation” for healthcare: Value = Quality/Cost. It was the first step toward bringing the healthcare industry together in acknowledgingtwo of the industry’s ugly truths. Costs of care were outpacing the quality of carereceived, yet the healthcare system was built around a fee-for-service payment modelthat rewarded providers for…
Price transparency in healthcare: Progress, barriers and next steps
Healthcare price transparency — the ability for consumers to understand how much their care will cost and how much they can expect to pay after insurance has paid its portion — is a top-of-mind concern for consumers. It’s also an area of increased focus for legislators and healthcare organizations. Yet despite industry acknowledgement that consumers…
Why it’s important to understand friction around claims denials
Payment for healthcare services starts with a claim that details what type of care the patient received, why and the amount charged by a hospital or provider for these services. From there, the claim is typically sent to the patient’s health plan for reimbursement. But the path to reimbursement for healthcare claims has become much…
Community benefit, 340B and Medicare Advantage: Top financial reporting challenges
Nonprofit hospitals are facing scrutiny over their community benefit reporting, the 340B Drug Pricing Program is under threat, and there is a need for greater transparency in Medicare Advantage and Medicaid managed care plans.
Revenue cycle management (RCM): The foundation of healthcare finance
Revenue cycle management in healthcare is the process of tracking revenue from patients, including patient registration, claim submission, reimbursement, and communication with insurance companies, and is essential for providing a positive patient experience.