Medical management is too often overlooked in hospitals’ workforce strategy
Hospital leaders understand better than most that health is not abstract. Every day, they see what happens when chronic conditions go unmanaged, behavioral health needs go unsupported and patients enter the system later than they should. Yet, when hospitals look inward at their own workforce, medical management is still too often treated as a benefits…
Why hospitals and health systems are trimming vendors from their AI roster
Hospitals and health systems’ relationship with AI is getting more refined as industry executives figure out what they want and don’t want from the software. For hospital and health system executives, that means identifying when their ROI in a given AI application is good enough to keep it in use, and depending on the use,…
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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…
Preventing denials before they happen: How revenue intelligence is reshaping the revenue cycle
Health systems continue to invest heavily in denial management. Yet denial volumes remain stubbornly high. The reason is simple: Most organizations are still focused on addressing denials after they occur rather than preventing them in the first place. Roughly 15% of claims are initially denied, and hospitals spent nearly $19.7 billion in 2022 appealing denied…
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…
Peer Insights Playbook: The People Side of Autonomous Coding
Learn how organizations expanded career opportunities, redesigned auditing processes, and gained buy-in from coders, executives, providers, and vendors to successfully adopt autonomous coding technology.
Prevent denials by catching credentialing issues
Verifying the credentials of ordering physicians should be an essential part of revenue cycle management, and it could prove to be a fruitful endeavor. Ximena Restrepo, compliance and privacy partner for Billings Clinic–Logan Health, which serves residents of Montana and Wyoming, said Billings-Logan has saved thousands of dollars in avoided claim denials or in avoided…
Prior authorization is draining revenue, which is why automation has become a strategic imperative
Prior authorizations have entered a different era. The process has become one of healthcare’s most expensive administrative bottlenecks, affecting far more than physician practices. Across hospitals and health systems, it slows patient access, adds labor-intensive work, increases denial risk, and puts pressure on reimbursement and cash flow. For organizations focused on growth, margin, and operational…
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.