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Why financial risk builds across the revenue cycle
Financial risk is rarely noticed at the point where it starts. A problem with eligibility or claim information becomes a denial. A reimbursement discrepancy turns into an underpayment. An unclear financial conversation leaves a patient unsure what they owe. By the time the impact shows up in accounts receivable or cash flow, the underlying issue…
Value-based care and alternative payment models: What they are and how they work
Value-based care (VBC) is an approach to healthcare that seeks to improve the quality, outcomes and experience of care while managing its cost. Rather than rewarding healthcare organizations solely for the volume of services they provide, value-based arrangements link some or all payment to measures of quality, outcomes, utilization or total cost of care. The…
Ways to align financial performance and the patient experience
In response to increased healthcare costs for patients, revenue cycle leaders are prioritizing patient balances and improving the financial experience while seeking solutions that support both patients and near-term financial performance.
Specialized enablement support to build and scale cell and gene therapy programs
Dive into this business profile to learn how health systems can develop a sustainable strategy to support broader patient access to cell and gene therapies (CGT).
What is denials management?
Understanding this key healthcare revenue cycle function One out of five adults say they have experienced a denied claim: when an insurance company refuses to pay for the healthcare services they’ve received or a prescription, according to a recent survey.[1] Yet only half of people appeal a denied claim, mostly because they aren’t sure how…
From fragmented outreach to coordinated action: building a value-based care operating model
Value-based care is operating at scale. In 2026, 511 Accountable Care Organizations in the Medicare Shared Savings Program serve approximately 12.6 million people with traditional Medicare, the largest beneficiary population in program history. CMS reports approximately $2.5 billion in net Medicare savings and $4.1 billion in shared savings for the most recently reconciled performance year.…
How Medical Practices Can Protect Revenue Through Compliance
By integrating proactive compliance and strong revenue cycle management workflows, practices can ensure accurate documentation and secure reliable, timely reimbursement. Dive into this article to learn more.
Revenue cycle sustainability demands more than cost-cutting
In this roundtable several revenue cycle management and finance leaders share their top challenges associated with revenue cycle transformation and lessons learned.
From reactive denial management to upstream prevention
Denials are usually discovered after adjudication. The revenue loss, however, often begins much earlier. Hospitals continue to invest significant time and resources in denial management, yet roughly 15% of claims are initially denied. Hospitals spend nearly $19.7 billion each year appealing them and only about half of those denials are ultimately overturned. That raises a…
HFMA Comments on CY 2027 Hospital OPPS and ASC Proposed Rule
HFMA presents its comment letter to CMS on the CY 2027 Hospital OPPS and ASC Proposed Rule.