What You Should Know:
- Blue Shield of California and Salesforce are joining forces to tackle a major pain point in healthcare: the lengthy and often frustrating process of prior authorizations.
- The new AI-powered platform solution, built on Salesforce Health Cloud, aims to deliver near real-time prior authorization decisions, streamlining healthcare delivery and improving patient experience.
Addressing the Burden of Prior Authorizations
Prior authorizations are a
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Revenue Cycle Management | News, Analysis, Insights - HIT Consultant
The Fine Print of Health Insurance: Why Surprise Bills Are So Common?
Surprise medical bills can be a major headache for anyone, but they can be annoyingly common for those with high-deductible health insurance plans (HDHPs). In fact, half of patients with an HDHP state they have received a surprise medical bill, even though they have insurance coverage.
High-deductible plans typically feature lower monthly premiums but higher out-of-pocket expenses. However, these plans can leave patients on the hook for unexpected medical costs that they may not be able to
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Tanner Health Partners with Corti to Revolutionize Medical Coding with AI
What You Should Know:
- In a move set to transform healthcare operations across Georgia and Alabama, Tanner Health and Healthliant Ventures have announced a strategic partnership with Corti, the trusted AI platform to healthcare systems worldwide.
- The collaboration is expected to significantly streamline medical coding, reduce administrative burdens by 80 percent, and enhance the overall accuracy of billing systems. This integration will empower healthcare professionals to spend less
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XiFin RPM Achieves HITRUST r2 Certification for Enhanced Information Security
What You Should Know:
- XiFin, Inc., a healthcare information technology solutions provider, has announced that its revenue cycle management (RCM) solution, XiFin RPM, has once again earned the HITRUST r2 Certification.
- The HITRUST r2 Certification is widely recognized as the most rigorous standard for information security in the healthcare industry. It validates that XiFin RPM meets stringent requirements for safeguarding sensitive patient data and maintaining compliance with
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Transforming Insurance Verification and Authorizations with AI
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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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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