How healthcare organizations navigate claims processing
View the results of a survey about claims processing and revenue cycle performance conducted with more than 625 healthcare leaders.
Leveraging extensible technology to create consumer-centric healthcare ecosystems
Implementing new technologies can eliminate tedious tasks and open the door for more impactful work as well as provide patients with easier access to convenient scheduling, registration and billing options. Dive into this roundtable for additional insight on technologies progressing the industry.
Healthcare providers seeing more diagnosis-related group downgrades and ghost denials
Each year, tens of millions of medical claims will be denied by healthcare payers. One executive director led a session with more than a dozen attendees highlighting their experiences with DRG downgrades and lessons learned to help other organizations better measure, manage and successfully appeal these complex denials.
The state of Medicare Advantage: As the program grows, healthcare stakeholders express concerns
As seen during a recent virtual conference, the accelerating expansion of Medicare Advantage (MA) has been accompanied by tension over growing pains such as regulatory issues. “I think MA was set up really well, but like anything else there’s sort of a moment where you have to look at the program and say: How do…
Healthcare News of Note: 3 factors increase the likelihood that a physician has been sued
Some46.8% of physicians over the age of 54 report they have been sued compared to 9.5% of physicians under the age of 40. The revenue cycle management segment accounted for the largest revenue share in the global healthcare finance solutions market in 2022. Greater representation of Black primary care physicians (PCPs) in the PCP workforce…
CMS issues RFI to gather best practices for identifying and supporting safety net hospitals
As part of the FY24 proposed rule for hospital inpatient payments, CMS is seeking healthcare stakeholder input on how to best support safety net hospitals in the Medicare program. The agency is considering ways to reimburse safety net hospitals via supplemental payments that may be better targeted than disproportionate share hospital (DSH) and uncompensated care…
Congress seems inclined to expand site-neutral payment policies in Medicare (updated)
Momentum is building in Congress toward expanding site-neutral payment in Medicare, a move that could reduce payments to hospitals by billions of dollars per year. A recent hearing, which lasted 5 ½ hours, focused on various ideas for promoting transparency and competition in healthcare. The hearing included references to 17 bills or discussion drafts, several…
The COVID-19 public health emergency is over: Here’s what healthcare providers should know
An era ends for the U.S. healthcare industry with the termination of the COVID-19 public health emergency (PHE) at the close of the day on Thursday, May 11. The termination means providers are losing many of the federal waivers and flexibilities that have been in place for all or most of the PHE, which took…
Turning it up in Music City: Get ready for HFMA’s Annual Conference in Nashville
HFMA’s Katie Gilfillan discusses plans for HFMA’s Annual Conference in Nashville. Learn more and register here. Also in this episode, Karie Ryan and Amy Pyke of Philips tackle some of healthcare’s greatest challenges with the strategic use of technology.
New data on No Surprises Act arbitration cases show providers are faring well amid systemic challenges
Providers are having success at challenging out-of-network payment amounts under the No Surprises Act, at least when they can get their cases through the arbitration system. CMS published an update showing that between April 15, 2022, when the independent dispute resolution (IDR) portal opened, and March 31, arbitrators issued payment determinations in 42,158 disputes. Initiating…