Medical billing and collections
Medical billing and collections ensure financial stability. Patient collections bridge gaps, securing payments directly from consumers. This financial stability enables providers to maintain high-quality care, invest in IT and sustain operations, ultimately enhancing patient outcomes and the overall delivery of healthcare services.
Top Stories
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News
05 Dec 2024
High-acuity inpatient stays up 41%, likely result of upcoding
The upward trend in high-acuity hospital stays and upcoding in medical billing have yielded billions in hospital reimbursements. Continue Reading
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21 Nov 2024
For-profit hospices linked to poor care quality
Researchers discovered that hospices owned by private equity firms and publicly traded companies were linked to poorer care quality. Continue Reading
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12 Nov 2024
Physician compensation totals 84% of medical group expenses
Medical groups might rethink operations in light of new Kaufman Hall data about physician compensation and overall employee investment/subsidy. Continue Reading
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01 Nov 2024
CMS, CFPB take on improper medical collections in Medicare
CMS and CFPB have issued a joint statement outlining prohibitions against medical debt collection for Medicare members exempt from cost-sharing. Continue Reading
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29 Oct 2024
Out-of-pocket healthcare costs tarnish patient experience
High out-of-pocket healthcare costs, plus poor health plan navigability, harm the patient experience and care access. Continue Reading
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21 Oct 2024
90% of medical coding staff worry about upcoding, fraud
Healthcare fraud, such as upcoding and unbundling, has medical coding and billing professionals worried about the industry. Continue Reading
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17 Oct 2024
How healthcare leaders can mitigate concentration risk
Healthcare organizations are especially susceptible to concentration risk, creating a single point of failure that can jeopardize operations, Forrester researchers suggested. Continue Reading
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10 Oct 2024
CFPB warns medical debt collectors of consumer rights laws
Medical debt collectors may not attempt to collect on debts that are inaccurate or inflated, according to the CFPB. Continue Reading
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04 Oct 2024
Healthcare M&A revenue reaches $13.3 billion in Q3 2024
Healthcare M&A surged in Q3 2024, driven by portfolio realignments and health system expansion into new markets, according to Kaufman Hall. Continue Reading
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04 Oct 2024
GAO: CMS failed to ensure price transparency data accuracy
CMS said it does not have the resources or bandwidth to manually monitor accuracy and completeness of hospital price transparency data. Continue Reading
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17 Sep 2024
CMS issues updated rural emergency hospital guidance
Updated CMS guidance walks organizations through the process of becoming a rural emergency hospital provider type. Continue Reading
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06 Sep 2024
WEDI explores issue of diagnosis codes in good faith estimates
WEDI encouraged HHS to weigh whether the inclusion of diagnosis codes should be required for good faith estimates sent to health plans by providers on behalf of insured patients. Continue Reading
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22 Aug 2024
16,000 No Surprises Act complaints yield $4M in relief
The 16,000 No Surprises Act complaints primarily related to air ambulance services. Continue Reading
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15 Aug 2024
14% of Americans carry 75% of nation's medical debt burden
Certain populations bear the brunt of the nation's medical debt burden, even as leaders work to relieve debt and remove it from credit reports. Continue Reading
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14 Aug 2024
Trauma activation charges 60% higher at for-profit hospitals
The variation in trauma activation charges cannot be fully explained by clinical need, but by trauma center ownership and type. Continue Reading
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12 Aug 2024
ICD-10 codes for SDOH, housing instability miss the mark
More than 70% of the time, ICD-10 codes for SDOH don't reflect a patient's self-reported housing security. Continue Reading
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31 Jul 2024
Private equity hospitals better off than non-investment hospitals
Hospitals acquired by private equity firms tend to be more financially stable compared to comparable non-private equity hospitals, according to a new study. Continue Reading
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10 Jul 2024
How revenue cycle management’s security needs are evolving
The recent cybersecurity attack on Change Healthcare has revenue cycle management vendors and clients prioritizing security and system changes. Continue Reading
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27 Jun 2024
How to measure the healthcare billing experience
A new initiative aims to create benchmarks for the healthcare billing experience to improve patient collection rates and overall engagement. Continue Reading
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25 Jun 2024
Local economies pay the price when hospitals charge more
A new study shows that hospital price increases lower payroll and employment at companies outside of the healthcare sector. Continue Reading
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05 Jun 2024
RCM vendor Waystar announces IPO launch
Waystar Holding Corp., a revenue cycle management software vendor, launched its initial public offering of 45M shares of its common stock. Continue Reading
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04 Jun 2024
Providers join call to stop FTC’s noncompete ban
About 230 national associations have requested the FTC to stay the noncompete ban slated to take effect this fall, pending legal actions. Continue Reading
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03 Jun 2024
Hospitals have a strong month as volumes return to normal
New data from Kaufman Hall show a return to normal care patterns, resulting in a relatively strong April for hospital financial performance. Continue Reading
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29 May 2024
Provider compensation rises again as groups push productivity
Healthcare providers and APPs saw significant gains in compensation for the fourth consecutive year as medical groups increased productivity. Continue Reading
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08 May 2024
Pandemic volume changes underscore rural hospital concerns
A new study finds rural versus urban hospitals saw more patient volume variability during the COVID-19 pandemic, highlighting their vulnerabilities to major shifts. Continue Reading
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07 May 2024
New AHA report paints dire financial picture for hospitals
A new report from the American Hospital Association finds that reimbursement is not keeping pace with the high costs of labor, drugs and supplies. Continue Reading
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06 May 2024
Hospital profitability dips as expenses bog down margins
The year-to-date operating margin index, as calculated by Kaufman Hall, fell 0.2 percentage points in March as expenses drove down profits. Continue Reading
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02 May 2024
Market consolidation worse among payers than health systems
New data from AAMC shows that the largest health systems have a combined 43% of market share in each state versus 82% among the top three large-group insurers. Continue Reading
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30 Apr 2024
Study: Lax antitrust enforcement boosting hospital prices
A recent study finds a link between lenient antitrust enforcement and reduced competition and higher prices for hospital care. Continue Reading
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25 Apr 2024
Why diversifying clearinghouse, banking partners is crucial
In the aftermath of the Change Healthcare cyberattack, hospitals should consider diversification of clearinghouses and banking partners to reduce risk. Continue Reading
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19 Apr 2024
Half of private equity-owned physician practices are resold within 3 years
Most private equity-owned physician practices resold within three years were sold to other private equity firms. Continue Reading
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18 Apr 2024
About 1 in 5 healthcare bankruptcies in 2023 owned by PE firms
A new report shows a wave of bankruptcies in PE-owned companies in 2023, especially in the healthcare sector. Continue Reading
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17 Apr 2024
Hospital merger and acquisition activity generated $12B in Q1 2024
First-quarter hospital merger and acquisition activity reflected ongoing trends, including cross-market transactions and portfolio realignment. Continue Reading
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17 Apr 2024
How Healthcare Technology Can Support and Guide Independent Practices
Technology can streamline workflows and increase efficiency as independent practices look to overcome major financial challenges, such as high denial rates and personnel shortages. Continue Reading
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16 Apr 2024
Nearly 4 of 5 physicians employed by hospitals, corporations
A new report also finds that nearly 6 of 10 physician practices are now owned by hospitals or health systems and other corporate entities. Continue Reading
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08 Apr 2024
Healthcare orgs reflect on top vendors for denials management services
Revecore received the highest overall performance score for denials management services based on limited data, while Aspirion had the highest satisfaction among fully rated firms. Continue Reading
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08 Apr 2024
Why keeping private practices independent is vital
Alliance Cancer Specialists has maintained independence from a major health system, but achieving that autonomy has been a journey. Continue Reading
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03 Apr 2024
Risant Health completes Geisinger acquisition
Geisinger is the first health to join Risant, a non-profit organization that aims to increase access to value-based care and coverage. Continue Reading
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02 Apr 2024
CMS releases tool to help hospitals with price transparency
CMS’ V2.0 Online Validator tool helps hospitals develop a machine-readable file to comply with federal price transparency requirements. Continue Reading
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27 Mar 2024
Primary care delivery is similar across all Medicare patient mixes
The rate of social needs screenings was low among primary care physicians serving primarily Medicare Advantage patients and those serving traditional Medicare patients. Continue Reading
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26 Mar 2024
Tax breaks higher than community investments for most non-profit hospitals
Non-profit hospitals spent an average of 3.87 percent of their budgets on community investments in 2021. Continue Reading
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18 Mar 2024
VisiQuate, MedeAnalytics top revenue cycle analytics rankings
A recent KLAS report found that VisiQuate topped third-party revenue cycle analytics rankings, while usability pushed MedeAnalytics close to the top. Continue Reading
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13 Mar 2024
Little progress made with hospital price transparency compliance
Only about a third of hospitals are fully compliant with federal price transparency requirements three years later, a new report shows. Continue Reading
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12 Mar 2024
Lower reimbursement rates, denials behind razor-thin margins
A survey of health system CFOs identifies major pain points, including lower reimbursement rates, more denials, and high labor costs. Continue Reading
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11 Mar 2024
Trauma center hospitals charged above-market prices for non-trauma care
Prices for non-trauma inpatient admissions were 4.4 percent higher at trauma center hospitals than at hospitals without a trauma designation. Continue Reading
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08 Mar 2024
Medical Debt Associated With Worse Population Health, Higher Mortality
Every $100 increase in median medical debt was associated with poorer population health, including 8.0 more physically unhealthy days and 6.8 more mentally unhealthy days per 1,000 people. Continue Reading
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07 Mar 2024
PE Practice Ownership Raises Concerns About Competition
A new study finds that private equity firms collectively held over 30% market share in over 100 MSAs and more than 50% in 60 MSAs. Continue Reading
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06 Mar 2024
January Hospital Margins Dip, But Overall Finances Remain Stable
Hospital margins fell 11 percent from December, but net and gross operating revenues both increased. Continue Reading
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05 Mar 2024
What’s Behind Private Equity’s Interest in RCM Vendors
New Mountain Capital’s offer to R1 RCM sheds light on private equity’s recent interest in RCM vendors, particularly outsourcing companies. Continue Reading
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04 Mar 2024
Non-Profit Health Systems Need Positive Margins
A new report from Deloitte underscores the need for non-profit health systems to generate positive margins for community benefits and more. Continue Reading
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28 Feb 2024
Patient Collection Rate Falls to Nearly 48%
A new analysis shows a sharp decline in the patient collection rate in 2022 and 2023 as providers write off more bad debt from patients with insurance. Continue Reading
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27 Feb 2024
R1 RCM May Go Private After $5.8B Private Equity Offer
Private equity firm New Mountain Capital has reportedly offered to purchase R1 RCM for about $5.8B, prompting considerations of going private. Continue Reading
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27 Feb 2024
How Robotic Process Automation Optimizes Revenue Cycle Management
Robotic process automation (RPA) saves practices money and time by automating manual, repetitive tasks within revenue cycle management. Continue Reading
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20 Feb 2024
What Ambulatory Providers Look for in Revenue Cycle Management Vendors
R1 RCM was the highest-rated revenue cycle management vendor among ambulatory provider organizations, KLAS shared. Continue Reading
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15 Feb 2024
How Do Providers Feel About Extended Business Office Services Vendors?
Providers value strong partnerships, transparency, and knowledgeable staff when seeking vendors offering extended business office services. Continue Reading
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14 Feb 2024
Half of US Rural Hospitals Operate at a Loss
Over 400 US rural hospitals are vulnerable to closure as more facilities operate in the red, according to an updated analysis. Continue Reading
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13 Feb 2024
Financial Woes, Care Delays More Common Among Adults with Medical Debt
Skipping medical tests and treatments and being contacted by debt collectors were common experiences for adults with medical debt. Continue Reading
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08 Feb 2024
Top Trends in Automation, AI Adoption in Revenue Cycle
Providers are energetic about automated technology in revenue cycle management, but it is not full steam ahead with adoption quite yet. Continue Reading
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07 Feb 2024
Highlighting Top Revenue Cycle Management Vendors By User Review
The Best in KLAS vendors have been named; here are the top financial and revenue cycle management companies you should know. Continue Reading
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07 Feb 2024
2023 Healthcare Bankruptcies Reached Highest Level in 5 Years
There were 79 healthcare bankruptcies in 2023, 12 of which had liabilities over $500 million. Continue Reading
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06 Feb 2024
Revenue Cycle Management, AI Take Center Stage in 2024
As CFOs expect profitability increases, revenue cycle management and tech investments become top priorities. Continue Reading
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02 Feb 2024
Hospital Finances Approach Pre-Pandemic Levels
2023 was a much more promising year for hospitals as margins improved by more than 15% compared to the previous year, Kaufman Hall reports. Continue Reading
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01 Feb 2024
Hospital Outpatient Departments Preserve Care Access for Rural Patients
Rural populations receiving care at hospital outpatient departments tend to be dually eligible for Medicare and Medicaid and have complex health conditions. Continue Reading
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31 Jan 2024
Healthcare Administrative Spending Increased by 50%
Staffing shortages, security challenges, and increased time needed to conduct transactions are behind a significant rise in healthcare administrative spending, CAQH reports. Continue Reading
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25 Jan 2024
Survey Reveals Revenue Cycle Management Concerns for 2024
As challenges persist, half of healthcare leaders plan to invest in new revenue cycle management technology in the next 12 to 18 months. Continue Reading
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24 Jan 2024
NYC Partners with Non-Profit to Relieve $2B in Medical Debt for Residents
New York City residents with low incomes and substantial medical debt will experience one-time debt relief through the partnership. Continue Reading
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23 Jan 2024
How to Adapt as Healthcare Workforce Management Shifts
Healthcare workforce management has changed since COVID-19, spurring organizations and candidates to rethink how they approach employment. Continue Reading
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22 Jan 2024
Steward Health Care Faces Financial Troubles, Possible Closures
Steward Health Care may have to close some facilities as the for-profit health system navigates financial distress. Continue Reading
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22 Jan 2024
Financial Distress Drove 2023 Merger and Acquisition Activity
Financial distress was cited as a factor in 28 percent of the 65 announced healthcare mergers and acquisitions in 2023. Continue Reading
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17 Jan 2024
How a GoFundMe Page Aims to Keep a Rural Hospital Open
A GoFundMe page for a rural hospital in PA is not only supporting local access to care but also raising awareness about the financial troubles of rural healthcare. Continue Reading
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16 Jan 2024
Healthcare Consumers Want Hospital Price Transparency, Survey Finds
A third of healthcare consumers believe Congress should prioritize hospital price transparency. Continue Reading
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12 Jan 2024
Hospital Finances Show Signs of Recovery as Revenues Rise
Revenue per adjusted discharge increased, while total expenses per adjusted discharge decreased in November 2023, signifying hospital finances may be improving. Continue Reading
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10 Jan 2024
Key Considerations For Choosing a Revenue Cycle Technology Vendor
Revenue cycle technology is key to improving efficiency, but success hinges on selecting the right vendor partner for the organization. Continue Reading
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08 Jan 2024
Medical Billing Quality Lacking According to Leapfrog Measures
Most hospitals don’t meet new medical billing measures added to the Leapfrog Group’s 2022 survey, a recent study shows. Continue Reading
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05 Jan 2024
Hospital Costs for Inpatient COVID-19 Treatment Rose 26% During Pandemic
Hospital costs for inpatient COVID-19 treatment increased more than five times the rate of medical inflation during the pandemic. Continue Reading
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04 Jan 2024
Private Equity Acquisition Tied to More Hospital-Acquired Conditions
Hospital-acquired conditions per 10,000 hospitalizations increased by 25.4 percent at private equity hospitals. Continue Reading
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02 Jan 2024
The Role of the Hospital Chargemaster in Revenue Cycle Management
The hospital chargemaster is how providers communicate medical bills to payers and patients and now plays an essential role in hospital price transparency. Continue Reading
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28 Dec 2023
Pros, Cons of End-to-End RCM Platform Adoption
A new KLAS report surveys deep adopters of RCM technology from a single vendor in the pursuit of an end-to-end platform. Continue Reading
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27 Dec 2023
74% of Hospitals Use Some Revenue Cycle Automation
More hospitals and health systems are automating revenue cycle operations, with many leveraging artificial intelligence. Continue Reading
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20 Dec 2023
Medical Groups Faced High Expenses, Staffing Challenges in 2023
From 2020 to 2023, medical groups’ revenue grew by 9.1 percent, while expenses increased by 26.5 percent. Continue Reading
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18 Dec 2023
32% of Academic Physicians Plan to Leave Workforce, Fueled by Burnout
Each one-point increase in burnout among academic physicians was associated with 52 percent higher odds of intention to leave. Continue Reading
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18 Dec 2023
NC Attorney General Sues HCA After Quality of Care Complaints
AG Josh Stein alleges HCA Healthcare has not provided quality, consistent emergency and cancer care following Mission’s purchase. Continue Reading
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14 Dec 2023
CMS: Healthcare Spending Accelerated, Reaching $4.5T in 2022
US healthcare spending grew by 4.1% in 2022, faster than the rate in 2021 but slower than in 2020. Continue Reading
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12 Dec 2023
R1 to Acquire Providence’s RCM Company Acclara
R1 RCM entered a definitive agreement to purchase Acclara from Providence for $675M in a deal expected to close early next year. Continue Reading
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07 Dec 2023
COVID-19 Surges Led to Fluctuating Occupancy Rates at Hospitals
During weeks with high COVID-19 admissions, inpatient and ICU occupancy rates grew while surgical occupancy declined. Continue Reading
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06 Dec 2023
Care Quality, Physician Autonomy Lower at Corporate-Owned Practices
Nearly 60 percent of physicians at corporate-owned practices said reduced autonomy led to lower patient care quality. Continue Reading
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04 Dec 2023
How Nursing Homes Can Prepare for Staffing Standards, Gaps
As nursing homes wait to see if the minimum staffing standards will be finalized, they should conduct staffing reviews and ensure they have a robust compliance program. Continue Reading
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01 Dec 2023
Fewer Than 1 in 3 Consumers Pay Medical Bills Immediately
A recent survey shows most consumers— 72% — don’t or can’t pay their medical bills in full right away, with affordability being a top barrier. Continue Reading
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30 Nov 2023
Hospitals See Margins Above Pandemic Levels in October
Hospitals are building financial resilience as performance improved in October, with margins above pandemic levels. Continue Reading
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29 Nov 2023
Optum Faces Allegations of Anti-Competitive Practices from CA Health System
Emanate Health alleged that Optum engaged in anti-competitive practices and tried to monopolize the primary care physician market the two organizations share. Continue Reading
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22 Nov 2023
WA Non-Profit Health System Will Reimburse Patients in Charity Care Agreement
The non-profit health system must also improve how it screens patients for charity care eligibility. Continue Reading
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20 Nov 2023
Generative AI Appeals to Healthcare Orgs for Revenue Cycle Operations
Nearly 60 percent of surveyed healthcare organizations are considering using generative AI for revenue cycle operations. Continue Reading
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14 Nov 2023
Breaking Down the Top 5 Healthcare Revenue Cycle KPIs
Healthcare revenue cycle key performance indicators (KPIs) enable providers to track financial health and adjust for optimal revenue capture. Continue Reading
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14 Nov 2023
HPSA Program Did Not Affect Physician Shortages or Health Outcomes
Counties saw no significant changes in mortality rates or physician density in the years following HPSA designation. Continue Reading
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09 Nov 2023
Revenue Cycle Sets Sights on Autonomous Coding, Claims Automation
Revenue cycle automation plans include autonomous coding and claims management tech, but cost and resource management are major barriers to adoption, KLAS reports. Continue Reading
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07 Nov 2023
27% of Adults Face At Least One Healthcare Affordability Challenge
Many US adults face severe healthcare affordability issues, such as high out-of-pocket costs, medical debt, or forgone care, but even more have healthcare financial strain. Continue Reading
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06 Nov 2023
Labor Expenses Hurt Hospital Financial Performance
Hospital financial performance declined slightly in September as providers deal with workforce issues, including rising labor expenses. Continue Reading
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06 Nov 2023
Consumer Credit Scores Improve After Medical Debt is Wiped from Reports
The average consumer credit score for those with medical debt in collections went from 585 to 615 points after credit bureaus removed debt under $500. Continue Reading
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02 Nov 2023
Hospital Outpatient Revenue Growth Contributes to Positive Margins
Between July and August 2023, hospital outpatient revenue increased by 11.6 percent. Continue Reading
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31 Oct 2023
Overcoming the Barriers to AI Adoption in Revenue Cycle Management
Barriers to AI adoption are getting in the way of revenue cycle management success, but providers can take steps to ensure technology works for them. Continue Reading
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27 Oct 2023
How Do Healthcare Organizations Feel About Autonomous Coding?
Healthcare organizations expect autonomous coding to speed up the revenue cycle process and improve coding accuracy, a survey found. Continue Reading
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26 Oct 2023
States Boosting Medicaid Payment Rates for Home Healthcare Amid Shortages
In addition to raising Medicaid payment rates, states have expanded worker education and training programs for home healthcare providers. Continue Reading