Across many healthcare organizations, front-office staff face a significant dilemma: patients seeking help only to be told that their health insurance verification and authorization process could take several days or even months. According to a study by the AMA, more than nine in ten physicians recently surveyed said that prior authorization negatively impacts patient clinical outcomes and, often, leads to treatment abandonment.
This issue mainly arises because current, manual insurance
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Revenue Cycle Management | News, Analysis, Insights - HIT Consultant
Mary Washington Healthcare Outsources Revenue Cycle Operations with Ensemble
What You Should Know:
- Mary Washington Healthcare (MWHC) has selected Ensemble, a provider of revenue cycle management solutions to outsource revenue cycle operations.
- The RCM outsourcing agreement will leverage Ensemble's innovative technologies and expert team to enhance MWHC's financial performance and elevate the patient financial experience.
Ensemble's Proven Track Record
With the addition of MWHC, Ensemble now manages an impressive $35 billion in annual net
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Claimable Launches AI-Powered Appeals Platform to Fight Unjust Healthcare Denials
What You Should Know:
- Claimable, a healthcare technology innovator, is taking on the pervasive issue of healthcare claim denials with the launch of its AI-powered appeals platform.
- This solution leverages advanced AI to analyze clinical research, policy details, appeals data, and patients' individual medical circumstances to generate and submit customized appeals in mere minutes.
Combating a Broken System
The U.S. healthcare system is plagued by an alarming rate of
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VisiQuate Acquired by Accel-KKR to Tackle Healthcare’s Revenue Leakage Crisis
What You Should Know:
- VisiQuate, a provider of advanced revenue cycle analytics, AI-powered workflow, and automation solutions, today announced its acquisition by Accel-KKR, a global technology-focused investment firm.
- The strategic acquisition marks a significant milestone for VisiQuate, enabling the company to leverage Accel-KKR's resources and expertise to further its growth and innovation in the healthcare revenue cycle management (RCM) space.
Addressing Healthcare's
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Claim Denials Surge as Healthcare Providers Struggle with Tech Adoption
What You Should Know:
- A new Experian Health study reveals a concerning trend in the healthcare industry: claim denials are on the rise, and healthcare providers are increasingly hesitant to embrace technology solutions that could alleviate this burden.
- The Experian Health 2024 State of Claims survey paints a stark picture of the challenges providers face in managing their revenue cycles.
The Growing Claim Denial Crisis
Compared to a similar study conducted in 2022,
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Finding Success Amid Complexity: 3 Payer Strategies for Better Risk Adjustment Results
Risk adjustment requires constant attention to ensure accurate coding, timely regulatory compliance, and streamlined communications across the payer-provider continuum. Increasingly rigorous oversight from the Centers for Medicare & Medicaid Services (CMS) and Office of the Inspector General (OIG) are calling for better diligence, planning and administrative oversight for effective risk adjustment.
The January 2023 rule from CMS, which struck the fee-for-service adjuster from risk
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Edifecs and HealthEdge Partner to Streamline Healthcare Data Exchange
What You Should Know:
- Edifecs and HealthEdge, two leading healthcare technology companies, have announced a strategic partnership to natively integrate Edifecs’ EDI Gateway offerings with HealthEdge’s HealthRules Payer claims adjudication system.
- This partnership will enable organizations to confidently navigate complex regulatory landscapes while also laying the foundation for future advancements in healthcare administration.
Enhancing Healthcare Data
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The Critical Importance of Payer-Provider Collaboration Goes Beyond Prior Authorization
The critical need to improve prior authorization processes might have reached its tipping point on Jan. 17. That’s when the Biden administration announced its new mandate — the CMS Interoperability and Prior Authorization Final Rule — designed to effectively speed up the process for Medicare Advantage patients, providers and health plans.
Speed is only one of many inefficiencies surrounding prior authorization. And prior authorization cases are only one slice of the patient
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CorroHealth Acquires Xtend Healthcare’s RCM Business from Navient
What You Should Know:
- CorroHealth, a healthcare technology and revenue cycle management (RCM) company, has successfully completed its acquisition of Xtend healthcare's RCM business from Navient.
- The acquisition significantly scales CorroHealth's existing RCM capabilities and introduces new patient engagement features. Notably, it adds multichannel patient communication functionalities, a crucial element previously missing from CorroHealth's suite of services.
- As part
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AI Agents in Healthcare: Retaining Talent, Improving Patient Care
The aging population is creating an unprecedented demand for healthcare services while the available healthcare workforce is declining. Meanwhile, the healthcare system continues to rely heavily on manual processes which have to date been powered by people. After a patient visit, a healthcare provider typically requires a full administration team to manage data across various systems, just to receive reimbursement
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