From back office to balance sheet: Why revenue cycle is becoming strategic AI infrastructure
Healthcare finance leaders are confronting a new reality: Revenue cycle performance now directly influences organizational stability, capital planning and access to care. Rising denial rates, expanding prior authorization requirements and persistent staffing constraints have transformed revenue operations from a transactional function into a strategic enterprise capability. Recent reporting from Kaufman Hall shows denials and revenue…
AI Adoption in denials management lags as other RCM uses expand
Denials management, one of the toughest tasks in hospital revenue cycle management (RCM), deserves more attention from AI experts, but RCM execs are not diving in with AI solutions for multiple reasons. About one in five healthcare providers apply AI to denials management, a 2025 Bain & Co. survey found. Instead, providers have turned more…
Value-based payment gains policy consensus after 15 years of CMMI models
Saying it’s time to phase out the fee-for-service payment model would have been controversial a decade ago, but today such sentiment is accepted in policy circles, according to insights from a recent webinar. In a discussion among past directors of the 15-year-old Center for Medicare & Medicaid Innovation (CMMI), a key takeaway was the degree…
CMS establishes tighter limits on the structure of Medicaid tax arrangements
Nearly seven months after passage of the legislation known as the One Big Beautiful Bill Act (OBBBA), finalized regulations from CMS apply additional constraints to the use of healthcare taxes as a Medicaid funding source. A rule set for formal publication Feb. 2 is intended to create Medicaid savings in part by reducing the matching…
Battle of the Bots intensifies over denials
Healthcare payer claim denials are getting smaller, sneakier and faster. The battle of the bots over healthcare claims payment delivered record blows in 2025, with initial denials sometimes occurring within seconds of submission.a “Payers are becoming more sophisticated in their use of AI, and the denials are coming faster than we can keep up,” said…
Affordability under pressure: How hospitals are responding to rising patient cost burdens
When the initial shock of a Stage 4 colorectal cancer diagnosis wore off, Tampa Bay, Florida, resident Tim McDonald, 57, says a new devastation quickly set in: The cost of what it might take to save his life. McDonald has been outspoken about his experience in dealing with colorectal cancer and has become a strong advocate for education…
Expiration of ACA enhanced subsidies would pose high financial risk for hospitals in 12 states
Amid a continuing push in Congress to extend the Affordable Care Act (ACA) enhanced subsidies, a new analysis identifies the states where expiration would have the biggest financial impact on hospitals. Not-for-profit hospitals in a dozen states are at high risk of negative credit shocks if the subsidies are not renewed, according to a Fitch…
How to maintain accurate coding amid staff shortages
Find out how one company pairs expert coding with technology-enabled workflows and rigorous quality checks to help organizations reduce denials, improve accuracy and maintain predictable revenue — allowing teams to stay focused on delivering excellent patient care.
Tips for healthcare leaders on choosing the right RCM partner
Read about how one company enables healthcare leaders to focus on strategic priorities — expanding access to care, improving patient experience and sustaining financial health.
Projected Medicare Advantage 2027 payment rate draws concern from plans and providers
CMS’s proposed Medicare Advantage (MA) 2027 payment rate would result in minimal overall growth for health plans, with average payments to MA plans projected to increase by only 0.09%, according to the MA advance rate notice published this week. MA policy increasingly has grabbed headlines in conjunction with the program’s enrollment surge from 33% of…