Redesigning denials management in the OBBBA era
Under OBBBA, executives face denials as a continuous operational and financial pressure. Traditional reactive approaches — reviewing and appealing after denials occur — are no longer sustainable. The organizations that succeed in this new era will use predictive analytics, automation and disciplined processes to prevent denials before they happen. The problem with the traditional model For decades,…
Healthcare Technology, Episode 2: Helping patients harness their own data
Patients have access to more data than ever, but there can be confusion when they try to interpret it. In this week’s episode, we speak with Tim Church, MD from Wondr Health and Jonathan Henderson from Encore Rehabilitation.
Cutting through the clutter: Practical strategies to reduce administrative waste in payer-provider interactions
Administrative costs in healthcare continue to rise, often consuming more resources than direct patient care. Nowhere is this more visible, or more solvable, than within revenue cycle management (RCM). These costs are not just a patient care concern; they strain the workforce and directly impact financial sustainability. Much of the challenge stems from a persistent…
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…
Successful implementation of RCM technology demands a collaborative approach
Providers need to look no further if seeking assistance in improving cash flow, navigating staffing shortages or enhancing technology infrastructure. Check out this article to discover tools and solutions for current healthcare trends.
AI and Automation in Revenue Cycle Research
A survey of 272 healthcare executives was conducted to understand how automation and AI are being utilized in their organizations and if not, what barriers or concerns they have to adopting new technologies.
How enhanced medical documentation can combat rising payer denials
Hospital executives across the country are increasingly frustrated with rising denial rates from payers. At a recent HFMA conference, revenue cycle leaders voiced concerns about what they perceive to be bad-faith payer denial practices. Although such frustrations have some validity, hospital leaders will accomplish little if they focus solely on payer behavior. Instead, they should…
New research report: Payer Provider Relationships
Review the results of a survey that explored executives' views on how AI could improve the payer-provider relationship and optimize revenue cycle management. Furthermore, learn about AI adoption within health systems.
Boost charge capture by bridging gaps between teams
This whitepaper identifies some of the most common underlying issues driving charge capture mishaps — and outlines a new path forward optimizing charge capture.
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…