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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Revenue Cycle Management | News, Analysis, Insights - HIT Consultant
Candid Health Secures $29M for Revenue Cycle Automation Platform
What You Should Know:
- Candid Health, the innovative revenue cycle automation platform designed for healthcare providers raises $29M in a Series B funding round led by 8VC, with participation from existing investors First Round Capital, BoxGroup, and Y Combinator.
- This latest investment brings the company's total funding to $47M.
Simplifying Medical Billing, Empowering Providers
Candid Health is committed to simplifying the complex and often frustrating process of medical
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CPT 2025 Code Set Released, Featuring AI Integration, Digital Medicine
What You Should Know:
- The American Medical Association (AMA) has released the CPT® 2025 code set, a comprehensive update that reflects the latest advancements in medical procedures and services.
- This year's release features 420 total changes, including 270 new codes, 112 deletions, and 38 revisions.
Key Updates in CPT 2025
CPT codes are essential for data sharing, billing, and reimbursement in the healthcare industry. The CPT 2025 code set was developed through a
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Navigating the Murky Waters of Healthcare Billing
The traditional fee-for-service healthcare model, which reimburses providers based solely on the quantity of services delivered, is undergoing a much-needed transformation. The choice now is of value-based care initiatives, that are more focused on improved patient outcomes and preventive care, rather than simply paying for services rendered.
At the core of this change is a fundamental realignment of the mission, processes, metrics, and cultural values for healthcare providers and clients,
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AI’s Advantages to Overcoming Revenue Cycle Management Challenges for Providers
Healthcare providers face staffing shortages, increasing regulatory requirements, and pressure to reduce costs while delivering effective care. Compounding provider problems are payor policy, behavior changes and ongoing fee schedule cuts that compress revenue, as well as mounting denials and additional documentation requests from payors.
Coding, claim processing, and the collective revenue cycle management (RCM) tasks required to ensure appropriate reimbursement for billable service are all
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5 Ways AI Streamlines Prior Authorization Process for Providers & Patients
The prior authorization process, integral for confirming the necessity and insurance coverage of medical treatments, has historically been an obstacle in healthcare. In its current state, it has the potential to cause considerable delays and financial burdens for patients and healthcare providers - and the inefficiencies of this process are evident, as approximately 90% of providers report care delays due to this process (AMA), with a significant percentage indicating that some delays even lead
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RCM M&A: Arsenal Capital Partners Acquires Knowtion Health
What You Should Know:
- Arsenal Capital Partners, a prominent private equity firm specializing in healthcare and industrial growth companies announced the acquisition of Knowtion Health. Financial details of the acquisition were not disclosed.
- Knowtion is a provider of AI-powered revenue cycle insurance claim resolution services that help hospitals and health systems optimize their operations and increase revenue.
A Strategic Investment
Arsenal's investment in Knowtion
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HealthEdge and Zelis Partner to Modernize Healthcare Payments
What You Should Know:
- HealthEdge and Zelis have announced a strategic partnership to streamline healthcare payments.
- The collaboration combines HealthEdge's next-generation core administrative processing system (CAPS) with Zelis' Advanced Payments Platform (ZAPP) to enhance efficiency, accuracy, and transparency in the payment process.
Creating Seamless Payment Process
By integrating their platforms, HealthEdge and Zelis aim to improve the overall experience for
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Hospitals: Integrating CDI and UM for Improved Revenue Cycle
Forward-thinking hospitals have long recognized clinical documentation integrity (CDI) and utilization management (UM) as priorities for a successful revenue cycle. The current economic climate only underscores their importance. The latest performance trends data from Strata Decision Technology noted that, while operating margins remain stable, payment volumes experienced a shortfall of nearly 18% in Q1 of 2024.
Now is the time for hospitals to explore how to further automate and
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Future-Ready: 10 Best Practices to Improve Prepay Claims Editing
In the fast-evolving and intricate landscape of payment integrity, the value of prepay editing is paramount. As powerful AI and advanced analytics are being applied earlier in the claim adjudication process, the importance of next-generation claim editing capabilities will separate health plan leaders from laggards.
If you’re equating claims editing with medical savings alone—you’re missing the boat and the opportunity. Because forward-thinking payment integrity and claims operations leaders
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