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Change Healthcare and HFMA partnered on a research study that analyzed the state of claims denials in the United States. It focused on understanding providers' first-pass claim rates, denials occurring from lack of pre-authorization and medical necessity processes, and pain points that are opportunities for innovation. 

A clinical documentation improvement (CDI) advancement ladder is a useful mechanism for attracting and retaining top talent among clinical documentation specialists in an increasingly competitive market. 

A monthly scorecard helped surgical departments reduce costs without requiring surgeons to follow a strict standardization process to limit the number of vendors.

An analysis found that hospital readmission reduction programs inconsistently provide net savings to health systems. The average net savings per heart failure patient was $972, but the study found a $169 net loss per patient among general populations.

Many organizations are establishing results management offices to guide outcomes, accountability, transparency, and responsibility. These offices serve as the primary oversight structure for driving cost transformation.

Montefiore’s care management approach includes embedding primary care and HIV care providers in methadone clinics and integrating behavioral health specialists in primary care practices.

Treating patients in the ICU who cannot benefit from that level of care may reduce positive patient outcomes and satisfaction, as well as introduce unnecessary costs.

The New Jersey Hospital Association coordinated learning collaboratives to help hospitals share their best practices for reducing patient harm while saving millions in unnecessary costs.

Health care accounts for about one-third of the total $78.5 billion costs attributable to the prescription opioid epidemic.

Julie Williamson, PhD, chief growth enabler for Karrikins Group, talks about healthcare trends and technology, as well as the changing roles of women and men in health care.