Revenue Cycle

New approaches to nonclinical workforce management

Five healthcare leaders in revenue cycle management and patient access share their approach to workforce management in a remote and/or hybrid model and lessons learned along the way.

HFMA September 29, 2023

CMS pressures states to restore Medicaid coverage for some beneficiaries who have been disenrolled

CMS says a recent edict to state Medicaid programs has partially stanched the ongoing wave of disenrollments in the program, with about 500,000 beneficiaries set to regain coverage they had lost and “many” others protected from disenrollment going forward. As described in a Sept. 21 summary, 29 states plus Washington, D.C., have acknowledged a systemic…

Nick Hut September 25, 2023

HHS sets new administrative fee to be paid by parties in No Surprises Act independent dispute resolution cases

Oct. 6 update: The lead section of this article was updated where noted with news about the arbitration portal. The administrative fee for taking out-of-network payment disputes to arbitration under the No Surprises Act in 2024 would be significantly lower than it was for much of 2023, but triple the current rate, according to proposed…

Nick Hut September 22, 2023

Driving dollars through data: An innovative way to improve self-debt collections

Recent industry trends indicate the challenge of self-pay collections within the revenue cycle management (RCM) space will continue to rise, driven primarily by the increasing number of consumers opting for high deductible health plans. Effective collections strategies require additional expertise to focus efforts where there is a higher return on investment. It’s time-consuming to chase…

HFMA September 20, 2023

As clock ticks toward massive Medicaid disproportionate share hospital cuts, proposed bill would bring relief

A congressional bill that would impose additional transparency requirements on providers also would offer a respite from a sizable cut to a key supplemental payment. A $32 billion reduction to Medicaid disproportionate share hospital (DSH) payments is scheduled to span four years, beginning when federal FY24 gets underway Oct. 1. The Lower Costs, More Transparency…

Nick Hut September 19, 2023

Legislation to enhance healthcare pricing and billing transparency takes a big step forward in the House

A slew of provisions on healthcare transparency took a step closer to becoming federal law as three House committees last week merged separate bills into a single draft. The resulting bill is just about set for consideration by the full House, where bipartisan support for the major provisions was apparent in the committee phase. The…

Nick Hut September 14, 2023

How predictive analytics and AI shed light on payer behavior

Providers and payers have become more collaborative as payment models evolve toward value. Still, payer-provider relationships can seem one-sided — decidedly in favor of the payer — as hospitals continue to face declining reimbursement and rising costs. The increase in denials is a great example, with rates skyrocketing by 20% over 5 years, according to…

HFMA September 11, 2023

Stemming the outpatient profit squeeze with a revenue cycle workflow gap analysis

Hospital and health system outpatient, outreach and ancillary services are often confined to EHR systems to manage their billing. Designed for bigger-ticket, lower-volume claims, these systems lack specific front-end intelligence, system connectivity, and automation necessary to efficiently manage these departments’ unique billing need. Too often, the result is an unnecessarily high number of submission errors,…

HFMA September 6, 2023

Patient access: The key to a healthy revenue cycle

As hospitals and physician groups face ongoing labor shortages and skyrocketing costs, maintaining effective Patient Access processes is critical. Ensuring efficiency and accuracy upstream helps prevent delayed reimbursement downstream—while supporting a positive patient experience. Download this whitepaper to explore the three patient access processes that can help protect revenue and improve the patient experience. Identify…

HFMA August 29, 2023

No Surprises Act litigation update: QPA methodology deemed illegal as Texas Medical Association wins in court again (updated)

Note: The first section of this article has been updated with the latest news on the status of the arbitration portal. The fourth victory in four cases brought by the Texas Medical Association (TMA) has implications for how insurers calculate the qualifying payment amount (QPA) used to arbitrate out-of-network payment sums under the No Surprises…

Nick Hut August 25, 2023
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