What is denials management?
Understanding this key healthcare revenue cycle function One out of five adults say they have experienced a denied claim: when an insurance company refuses to pay for the healthcare services they’ve received or a prescription, according to a recent survey.[1] Yet only half of people appeal a denied claim, mostly because they aren’t sure how…
Revenue cycle sustainability demands more than cost-cutting
In this roundtable several revenue cycle management and finance leaders share their top challenges associated with revenue cycle transformation and lessons learned.
Bad debt and charity care expenses climbing, expected to go even higher
Patients are already showing signs that it is getting more difficult for them to pay their hospital bills, even before the coming major funding cuts expected to take place in 2027. A recent signal came in the form of Kaufman Hall’s National Flash Report, which is based on June data, indicating that bad debt and…
From reactive denial management to upstream prevention
Denials are usually discovered after adjudication. The revenue loss, however, often begins much earlier. Hospitals continue to invest significant time and resources in denial management, yet roughly 15% of claims are initially denied. Hospitals spend nearly $19.7 billion each year appealing them and only about half of those denials are ultimately overturned. That raises a…
Integrating human-enabled AI emerges as key consideration for revenue cycle
In this roundtable, healthcare revenue cycle leaders and executives explore how to move toward thoughtful AI adoption that makes an impact in protecting revenue integrity.
The CFO playbook for revenue cycle performance
Discover how healthcare CFOs improve revenue cycle performance and protect margins through an integrated, AI-enabled approach to documentation, coding, compliance, and denial prevention.
CMS updates prior authorization transparency requirements for health plans
As part of efforts to improve prior authorization, CMS has bolstered its transparency requirements for health plans. Based on 2024 regulations that partially took effect in 2026 and are intended to promote electronic prior authorization, new requirements apply to health plans in Medicare Advantage (MA), Medicaid managed care and the Affordable Care Act marketplaces, along with state…
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…
CMS proposes new 340B reporting and HOPD attestation requirements
Recently published editions of two annual Medicare proposed rules both included provisions creating new administrative tasks for hospitals. CMS’s proposed rule for hospital outpatient care would formalize a system of required attestation for off-campus hospital sites starting in 2028, while the rule for physician payments would establish obligatory submission of 340B-related data to a centralized…
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…