Report quantifies the financial impact of certain health plan business practices on providers
As hospitals seek to regain their financial footing coming out of the pandemic, they may find themselves stymied by commercial payer policies, according to a new report. “It’s true that commercial payers might generate more net revenue than public payers on a per-case basis,” Crowe states in a report it recently published. “But at what…
How healthcare organizations navigate claims processing
View the results of a survey about claims processing and revenue cycle performance conducted with more than 625 healthcare leaders.
Healthcare providers seeing more diagnosis-related group downgrades and ghost denials
Each year, tens of millions of medical claims will be denied by healthcare payers. One executive director led a session with more than a dozen attendees highlighting their experiences with DRG downgrades and lessons learned to help other organizations better measure, manage and successfully appeal these complex denials.
CMS and other stakeholders take steps to improve prior authorization in Medicare Advantage and beyond
Several recent developments point to an industrywide effort to ease the burden of prior authorization. Most notably, CMS on April 5 finalized a rule that includes provisions designed to improve prior authorization in Medicare Advantage (MA) starting with the 2024 plan year. The rule addresses a few aspects of prior authorization, among them the way…
The impact of claims denials on the financial health of healthcare
While their hospitals and healthcare centers have long had to deal with claims denials, the number of denied claims continues to rise and payers are showing little inclination to help solve the problem, according to several roundtable participants.
Monument Health revamps its revenue cycle leadership structure for the benefit of patients and the organization
Looking to break through the cultural silos that can hamper operations at hospitals and health systems, Monument Health has engineered a new brand of clinical-finance collaboration. Headquartered in Rapid City, South Dakota, the community-based health system established a dyad leadership structure in which a clinical leader has joint oversight of the revenue cycle. It’s a…
News Briefs: 2023 brings a steep fee hike for No Surprises Act arbitration cases
The No Surprises Act’s independent dispute resolution (IDR) process has become more expensive for healthcare stakeholders. For the new year, the nonrefundable administrative fee due from each party involved in any payment dispute that goes to arbitration increased from $50 to $350, according to a Dec. 23 memo from CMS’s Center for Consumer Information and…
Key points to know in recently proposed rules for Medicare Advantage and the ACA marketplaces
A proposed rule for health plans in Medicare Advantage has provisions designed to stem overreach in prior authorization processes.
Labor costs and other concerns dampen the outlook for not-for-profit hospitals this year
Insights from a leading credit-rating agency illustrate the scope of the financial challenges facing not-for-profit hospitals in 2023.
How healthcare organizations can defend against financial hazards in 2023
What are the most critical strategies to steer healthcare organizations in the direction of financial stability in the following year and beyond? A couple tips include reducing bad debt and accessing external benchmarks for supply pricing.