Battle of the bots: As payers use AI to drive denials higher, providers fight back
Two fighters face each other in the ring, circling together, assuming there will be a single victor. One, representing the U.S. health insurance industry, has made huge investments in aggressive technology over the past several years to automate claim processing and reviews, making it hard for the other fighter — representing the nation’s healthcare providers…
Navigating healthcare’s cyber crisis: HFMA’s lifeline through the Change Healthcare cyberattack
Regularly scheduled national member calls by HFMA’s Change Healthcare Business Continuity Workgroup and frequent news updates about the continuing impact of the cyberattack on hospitals and health system by senior editor Nick Hut became a lifeline for many HFMA members through mid-March. Regular news updates Hut kept members apprised of developments starting on Feb. 25…
Navigating medical necessity denials: Strategies for successful resolution
Just as hospitals, health systems and physician practices are dealing with unprecedented financial and operational challenges, denied claims continue to rise — especially medical necessity denials. The impact on providers and patients is significant. Medical necessity is the term used to describe “healthcare services or supplies needed to diagnose or treat an illness, injury, condition,…
How digital patient engagement solutions can help healthcare organizations improve their existing revenue cycle
This roundtable features various healthcare professionals who breakdown what digital patient engagement solutions are being implemented and how this not only empowers patients, but also helps organizations looking to improve their existing revenue cycle.
While increasing revenue is a top goal for 2024, improving the patient experience is a close second — specially for large health systems: HFMA poll
In a recently conducted survey, 70% of 92 respondents said increasing revenue is a top priority in 2024 followed by improving the patient experience (60%) and reducing costs (55%). Review other key findings in this research report.
Healthcare Blame Game: Bloomberg Philanthropies puts $250 million into educating new healthcare workers while Patient Rights Advocate spends on spreading misinformation
Chad Mulvany, vice president of federal policy for the California Hospital Association and former HFMA policy director, discusses Bloomberg Philanthropies $250 million investment in the future healthcare workforce, as well as what will actually move the needle on price transparency.
Cyberattack on Change Healthcare brings turmoil to healthcare operations nationwide
This blog presents HFMA’s running coverage of the Change Healthcare cyberattack and its impact on providers and the healthcare industry. July 29 updates A recent HFMA news article examined both UnitedHealth Group’s latest quarterly financial report and lingering issues for providers amid the ongoing cyberattack recovery. Receiving electronic remittance advice files remains a problem with…
New data shows providers continuing to win most No Surprises Act independent dispute resolution cases
Providers won a large majority of disputes initiated during the first half of 2023 through the No Surprises Act’s arbitration portal for adjudicating out-of-network payments, according to newly published data. HHS and the U.S. Departments of Labor and Treasury released public-use files (available to download here under “2023 Reporting Year”) showing the outcome of every…
Hospitals reached steadier ground financially as they moved into 2024
Hospitals came into 2024 with some financial momentum, even as expenses continued to rise and pivotal decisions loomed. The year-to-date median hospital operating margin reached 2.3% in December, the high mark for 2023 and the 10th consecutive month in which margins were positive, according to monthly data from Syntellis Performance Solutions, part of Strata Decision…
Strategies for success: Tackling common clinical documentation integrity challenges head-on
Clinical documentation, which includes a record of exams, symptoms, diagnoses, medications, tests, treatments and other elements of a patient’s medical care, plays a vital role in creating a complete picture of an individual’s health and is needed to develop effective care plans. It also ensures that all providers who see the patient have access to…