Labor costs and other concerns dampen the outlook for not-for-profit hospitals this year
Insights from a leading credit-rating agency illustrate the scope of the financial challenges facing not-for-profit hospitals in 2023.
4 tips for simplifying prior authorizations
Healthcare spending in the U.S. has reached what many consider to be unsustainable levels. While spending in other developed nations averaged 8.8% of GDP in 2019, it was nearly double that in the U.S. at 16.8%. One of the major contributors to this spending is administrative waste, which accounts for up to 30% of our…
Medicare contractors should more closely examine providers’ bad debt claims, HHS watchdog says
Medicare administrative contractors (MACs) soon could apply more scrutiny to providers’ reported bad debts if CMS implements recommendations from the HHS Office of Inspector General (OIG). OIG in December issued a report in which it examined bad-debt reimbursement claims on Medicare cost reports spanning 2016 through 2018 for 67 randomly selected providers (including 29 hospitals). In those…
For the No Surprises Act arbitration process, 2023 brings a steep fee hike and continuing litigation
The No Surprises Act’s independent dispute resolution (IDR) process is about to become more expensive for healthcare stakeholders. In 2023, the nonrefundable administrative fee due from each party involved in any payment dispute that goes to arbitration will increase from $50 to $350, according to a Dec. 23 memo from CMS’s Center for Consumer Information and Insurance…
Massive federal spending bill alleviates reimbursement concerns for hospitals, but less so for physicians
Healthcare provider advocates applauded the inclusion of key reimbursement relief measures and other policies in a proposed federal spending bill for FY23, although physician groups expressed concern about the outlook for their constituents. With a divided Congress looking to muster the votes to pass the legislation before a self-imposed deadline of week’s end, the bill includes many…
International member spotlight: Aleetta Baby uses certification to enrich her career and look to the future
Aleetta Baby’s enthusiasm for her work is evident in her dedication to learning new skills. “I enjoy working in revenue cycle management because each day presents a new learning opportunity, task or challenge.” Baby, revenue cycle management financial analyst at Sheikh Shakhbout Medical City (SSMC) in Abu Dhabi, has completed her Certified Revenue Cycle Representative (CRCR) certification…
The hospital labor picture could be improving, but a full financial recovery isn’t imminent
The financial and operational stress that has hampered hospitals may be easing in some ways, but probably not enough to qualify as a holiday gift for a beleaguered industry. Recent reports from credit-rating agencies have presented a mixed outlook. For example, Fitch Ratings released an analysis in December showing “incremental signs of improvement” in the staffing situation…
Vanderbilt Health harnesses data to improve revenue cycle management
Close to half of healthcare finance professionals say in a survey that their organizations are experiencing a severe shortage of revenue cycle management (RCM) talent — and many are exploring automation as a way to keep RCM operations working properly. It’s a move that Vanderbilt Health in Nashville, Tennessee, made just prior to the pandemic — and…
How to automate revenue cycle operations to improve revenue and reduce resource dependency
Even with an increased focus on automation in the industry, too many revenue cycle operational processes remain highly manual and resource intensive. This is especially true for mid-cycle processes. Manual data entry, such as coding, leaves significant room for error and takes longer to complete, leading to slower reimbursement and ultimately impacting the bottom line. Automation…
New federal rule aims to eventually ease prior authorization processes
CMS is seeking to improve the prior authorization process in government programs such as Medicare Advantage (MA) and Medicaid, although the core provisions would not begin until 2026. The agency this week updated a Trump administration proposed rule with new proposals to “improve patient and provider access to health information and streamline processes related to prior authorization…