AI must earn its place in healthcare operations by showing its value
Healthcare leaders should evaluate AI and automation investments based on measurable outcomes, organizational priorities, and their ability to improve revenue cycle performance and workflows.
The autonomous mid-cycle keeps the patient story intact
AI-powered platforms can improve revenue cycle accuracy by connecting clinical documentation and coding across the patient journey, allowing healthcare professionals to focus on cases requiring human judgment.
Future-forward RCM: deterministic at the core, agentic at the edge
The future of revenue cycle management combines traditional automation for routine tasks with agentic AI to resolve complex reimbursement issues, escalating cases to human experts when judgment is needed.
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 An outdated coverage record, missing authorization or unresolved identity mismatch can pass through patient access and surface only when payment is delayed.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.…
Utilization review, HIPAA updates and more
Nick Hut talks with HFMA’s Kathy Stull about the Medicaid work requirement and 340B developments. Erika Grotto discusses utilization review with Kevin Coloton, CEO of HURC and HIPAA updates with Jon Bilotti, enterprise technology consultant at BCS365.
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…
FastFinance: Patient collections trends; SDP cuts rule
HFMA’s FastFinance newsletter is now a podcast. Host Rich Daly discusses the most current and relevant healthcare news, delivered in an easily digestible format. Hospitals and health systems have improved their front-end patient collections over the last year. But back-end collections are faltering. Also, this week’s Weird Number: $1.3 billion. That’s the amount of Medicaid…
Focus on patient care and access transcends hospital-centric model
Healthcare is shifting from a hospital-centric model to a more distributed, digital and patient-focused system, requiring revenue cycle management to evolve into a strategic enterprise capability. By leveraging AI, automation and revenue cycle data, health systems can reduce barriers to care, improve patient outcomes and strengthen financial resilience amid growing operational and reimbursement pressures.