Health system PBM ownership model shows benefits amid reform pressure
Amid heightened scrutiny of the pharmacy benefit manager (PBM) model, one health system is touting an alternative approach. St. Louis-based SSM Health is co-owner of Navitus Health Solutions, a PBM with 18 million members among 800 clients across all 50 states. Navitus has a niche that helps it optimally serve customers while bolstering the operation…
CMS’s claims attachments rule sets deadline to shift to full electronic submission
March 30 update CMS sent out an email announcing a town hall to discuss the new final rule. The town hall takes place Tuesday, March 31 between 1 p.m. and 2:30 p.m. Eastern time. No registration is required. The town hall can be joined at this Teams link. As there will not be a live…
Getting more bang for the buck from AI: Insight from Privia Health
An extensive search for the right AI implementation partners is paying off for Privia Health Group in Arlington, Virginia, an HFMA MAP Award winner that boasts positive results from incorporating AI in its revenue cycle. Privia, a publicly traded physician management company, has installed or will be installing AI in a variety of applications. Vendors…
2026 MAP Awards presented to 20 organizations for revenue cycle performance
CHICAGO (March 18, 2026) – The Healthcare Financial Management Association (HFMA) announced the 2026 winners of the MAP Award for High Performance in Revenue Cycle, including three integrated delivery systems, eight hospital systems, four individual hospitals, two critical access hospitals and three physician practices. “We want to congratulate these award winners for their dedicated efforts to strengthen…
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…
Drive strategic growth with smarter workforce planning
While enterprise resource planning (ERP) systems serve as the backbone for organizational operations, managing transactional and finance-centric processes, human capital management (HCM) systems focus on the employee lifecycle, helping to build trust, boost productivity and empower talent.
Gen AI is coming for medical bills: 3 ways to prepare
Patients are behind one of the latest applications of AI to the healthcare revenue cycle, and they are using it to review their bills. Stories of consumers using ChatGPT or other generative AI tools to trim thousands from their medical bills by questioning charges are appearing in the news and social media. YahooFinance wrote about…
Healthcare providers seek solutions for growing patient financial burden
According to an HFMA survey conducted on behalf of PayZen, 76% of patient bills are going uncollected. Providers are concerned the number of uninsured patients will increase due to regulatory shifts causing loss of Medicaid coverage. Learn more in this discussion about emerging solutions and strategies.
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…
News Briefs: White House healthcare plan would have major implications for the industry
President Donald Trump announced a healthcare framework aimed at boosting transparency, consumer choice and affordability, although numerous details still need to be decided before Congress can act on the proposals. The plan’s Jan. 15 release came as Senate talks to renew the expired ACA subsidies stalled amid disputes over abortion coverage and concerns about cost.…