Finding the right 5%: How predictive analytics is reshaping population health management
Healthcare organizations face a familiar challenge: identifying which members are most likely to experience clinical deterioration before costly complications occur. As financial pressures intensify and workforce shortages continue, health plans, employers and provider organizations must allocate limited care management resources with increasing precision. The question is no longer whether organizations should stratify risk — it…
Dispute resolution likely to be more disruptive as a result of new rule
A recently released CMS final rule concerning independent dispute resolution (IDR) mediation likely will cause a further bottleneck of No Surprises Act-based appeals, experts said. In the final rule, the fees were set at $15, down from $115 paid before the proposed rule came out. CMS in its proposed rule had originally set the revised…
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…
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…
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…
Operational resilience is the revenue cycle management imperative of the OBBBA era
The One Big Beautiful Bill Act (OBBBA) has altered Medicaid eligibility in ways hospitals can no longer treat as a background policy issue. Reverification of Medicaid coverage now happens so frequently that patients lose coverage for administrative reasons that have nothing to do with whether they actually qualify. Much of the industry dialogue has centered…
How principles of 4DX helped a health system transform its revenue cycle
On observing successful applications of the 4 Disciplines of Execution (4DX) across multiple industries, Emory Healthcare undertook an innovative approach in strategically using the performance management tool to solve revenue cycle challenges. Health systems nationwide face profound challenges in the revenue cycle, including those posed by preauthorizations, coding intricacies and payer denials, where solutions often…
Nov. 17, 2025: The shutdown is over, plus Aetna’s update to a controversial payment policy
Nick Hut and Shawn Stack discuss the longest shutdown in American history, and what might come next. Then, they tackle Aetna’s latest policy update.
Rethinking rev cycle, plus the 2026 Medicare proposed rule on physician fee schedule
Mayank Pant from IKS Health talks about why healthcare organizations haven’t been able to overcome longstanding challenges, and Nick Hut talks with HFMA Policy Director Katie Gilfillan about the 2026 Medicare Proposed Rule on physician fee schedule.