Medicare providers in hospitals and skilled nursing facilities (SNFs) are adjusting to new split/shared services documentation and billing regulations rolled out by the Centers for Medicare and Medicaid Services (CMS) as part of the 2024 Medicare Physician Fee Schedule (MPFS) final rule. The most notable change within the new regulations, which took effect on Jan. 1, 2024, is the finalization of CMS’s definition of the “substantive portion” of a split/shared evaluation and management (E/M)
Read More
Revenue Cycle Management | News, Analysis, Insights - HIT Consultant
Wolters Kluwer Health Unveils AI-Powered Tool to Help Medicare Advantage Plans Ace Risk Adjustment Audits
What You Should Know:
Wolters Kluwer Health, a leading provider of healthcare information and analytics, has introduced a new weapon in the fight against potential financial penalties for Medicare Advantage Organizations (MAOs) – the Regulatory Audit Module.
- The AI-enabled tool leverages artificial intelligence (AI) to streamline the risk adjustment audit process, potentially saving MAOs millions of dollars.
The Challenge: A Complex and Costly Regulatory
Read More
The AI Blueprint: An Implementation Guide for Revenue Cycle Leaders
Applying artificial intelligence (AI) solutions in hospitals and health systems can be overwhelming for leaders due to AI’s complexity (it’s not one technology, but several) and rapid proliferation. This is in addition to the usual technology hurdles within healthcare that include data quality and accessibility, interoperability, and clinical validation and adoption. Finally, with any new solution, there’s the concern of return on investment: Will implementing the latest solutions pay off for my
Read More
ChrysCapital Looks to Sell GeBBS Healthcare Solutions for $1B
What You Should Know:
- ChrysCapital, India's largest homegrown private equity (PE) firm, is reportedly exploring the sale of GeBBS Healthcare Solutions, a Los Angeles-based healthcare business process outsourcing (BPO) company.
- This comes roughly six years after ChrysCapital acquired GeBBS in 2018. The potential $1 billion valuation reflects a significant increase from the acquisition price in 2018. This transaction could signal ChrysCapital's strategy of entering a
Read More
Tower Health Selects Ensemble Health to Outsource Revenue Cycle Operations
What You Should Know:
Tower Health and Ensemble Health Partners (Ensemble), the market leader in end-to-end revenue cycle outsourcing for mid-sized to large healthcare organizations, announced today that they will enter into a strategic partnership for the management of all revenue cycle operations.This partnership will allow Tower Health’s hospitals and physician practices to focus on delivering exceptional care in their communities while Ensemble manages day-to-day revenue cycle
Read More
Physician Practices Struggle After Change Healthcare Cyberattack: Unpaid Claims, Staff Strain, and Potential Closures
What You Should Know:
- A recent American Medical Association (AMA) survey reveals the ongoing crippling effects of the Change Healthcare cyberattack on physician practices across the United States.
- The survey was conducted after UnitedHealth Group (UHG) said that claims would be flowing by the weekend of March 23. Despite UHG’s assurances, the attack, which began in February 2024, has disrupted claim processing and caused significant financial strain, jeopardizing patient
Read More
Availity Launches AI-Powered Claims Denial Prediction Tool
What You Should Know:
- Availity, a real-time health information network launches Predictive Editing, a revolutionary feature within its Availity Essentials Pro™ platform.
- The AI-powered tool developed in partnership with Anomaly Insights empowers healthcare providers to significantly reduce claim denials, leading to smoother revenue cycle management and improved financial performance.
The Problem: Costly Claim Denials
Denied claims are a major pain point for healthcare
Read More
Talkiatry & Cedar Partner to Tackle Mental Health Payment Woes
What You Should Know:
- Talkiatry, a provider of in-network psychiatric care, has partnered with Cedar, a healthcare financial engagement platform, to optimize the billing experience for their patients.
- The strategic partnership prioritizes not only mental health treatment itself, but also the financial barriers that often prevent individuals from seeking or continuing care.
Mental Health Crisis Demands Solutions
The United States faces a significant mental health crisis, with one
Read More
The ‘Holy Grail’ of Coding Automation: Why Inpatient AI is Around The Corner
Autonomous inpatient coding. This may sound like a pipe dream for revenue cycle leaders, whose hopes were likely raised and crushed in the early aughts. But it's coming sooner than most think.
Why is true inpatient coding automation the "holy grail" – as Kerry Gillespie, a former CFO at Intermountain Health and now an executive consultant at Warbird Consulting Partners, said to me at a Healthcare Financial Management Association roundtable last year?
For decades, inpatient services have
Read More
Sutter Health Partners with Abridge to Reduce Clinician Burnout with GenAI-Powered Documentation
What You Should Know:
- Sutter Health, a leading California healthcare system, announced a major collaboration with Abridge, a company specializing in generative AI for clinical documentation.
- The strategic partnership aims to transform the way physicians document patient interactions, ultimately improving patient care and reducing physician burnout.
Abridge: Streamlining Documentation and Freeing Up Physician Time
Physicians nationwide spend a significant amount of time on
Read More
