HHS report raises scrutiny of gender-affirming care billing and coding
HHS followed up its final rule blocking Medicaid funding for gender-affirming care in minors by publishing a commissioned report alleging “potentially fraudulent” billing and coding among providers of the services. The report, released Aug. 13, alleges that financial incentives drove hospitals and physicians to expand access to the care, and that deceitful billing practices took…
Patient matching bill could save $2.5M per hospital
Support is growing in Congress and in the healthcare industry to enact a national patient matching framework that would save billions of dollars in denied claims for hospitals and health systems. Most recently, two U.S. Senators, Mark Warner (D-Va,) and Jim Banks (R-Ind.), introduced the MATCH IT Act, a companion bill to House Bill HR…
From data capture to denial prevention: Strengthen patient access upstream
Revenue loss is often discovered after adjudication, but the conditions that created it may have entered the account days or weeks earlier. An outdated coverage record, missing authorization or unresolved identity mismatch can pass through patient access and surface only when payment is delayed. By then, the organization is managing rework rather than preventing it.…
Patient POS collections pose a growing problem for RCM departments
Hospitals are collecting more of the amount owed by patients at the point of service (POS), but that effort is failing to put a dent in the overall collection rates by hospitals, according to a new report from Kodiak Solutions. The report notes that healthcare providers are getting better at collecting from patients, but the…
Health systems boost front-end collections
Amid rising bad debt, health systems are improving front-end collections, according to surveys. Pre-service collections as a share of self-pay collections have improved from an average of 16% in 2025 to 21% in 2026, which signals that more organizations are capturing revenue successfully before care is delivered, according to a survey of 205 healthcare revenue…
5 keys to enhancing automation, expanding capacity and improving efficiency to reduce costs
Healthcare organizations in 2026 are operating under sustained financial strain. Margins remain compressed, workforce shortages continue, payer requirements are more complex and patient financial responsibility has increased. At the same time, many revenue cycle operations still rely on fragmented systems and manual processes that limit efficiency and delay cash flow. The traditional, reactive revenue cycle…
How to handle the revenue cycle skills gap
Revenue cycle management is becoming less about managing transactions and more about technology, as hospital finance departments shift toward AI-enabled workflows. Increasingly, skills valued by hospital and health system employers are aligning around automation and analytics. As Heather Dunn, chief revenue officer at Novant Health, said in “The Revenue Cycle of the Future,” a recently…
Fee-for-service payment approach creates obstacles to AI adoption by physicians
AI is poised to transform how healthcare is provided and paid for, but the commonly used fee-for-service (FFS) model of reimbursement could be a problem in getting physicians to adopt clinical AI tools, a group of researchers has found. The sticking point is that when a physician uses AI clinical technology or software in an…
Revenue cycle as enterprise infrastructure: Building financial resilience in 2026
Healthcare finance leaders are confronting a new reality: Revenue cycle performance is no longer just an operational task — it’s a central driver of financial sustainability and organizational resilience. Rising payer complexity, increasing patient financial responsibility and the persistent pressure of workforce shortages are forcing a strategic reappraisal of how revenue operations are structured and…
From billing to strategy: Elevating the patient financial experience
In 2026, the patient financial experience is no longer a “nice to have.” It is a revenue integrity issue, a trust issue and, increasingly, a competitive differentiator. Patients are carrying a larger share of healthcare costs than ever before. At the same time, their expectations are shaped by digital banking, retail and subscription services. When…