The concept of “revenue integrity” hasn’t really changed over the years, but the roles, responsibilities, and oversight have become far more complex and difficult to gain industry consensus around. What began as several defined systems of controls by which hospitals guarded against revenue loss, revenue integrity has seemingly turned into more narrowly focused controls in many organizations, leaving critical gaps in what once was a more holistic approach to fiscal
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Revenue Cycle Management | News, Analysis, Insights - HIT Consultant
Firstsource Acquires Quintessence to Bolster AI-Powered Revenue Cycle Management Solutions
What You Should Know:
- Firstsource Solutions Limited (FSL), a leading global provider of Business Process Management (BPM) services, announced the acquisition of Quintessence Business Solutions & Services Private Limited (QBSS).
- The strategic acquisition strengthens Firstsource's position in the healthcare revenue cycle management (RCM) market, particularly in the United States. Financial details of the acquisition were not disclosed.
Enhanced RCM
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How AI Can Increase the Success of Clinical Denials Appeals
It’s a perfect storm of financial pressures facing healthcare provider organizations – from rising costs to labor shortages to constrained capacity – that stymies revenue growth. Growing challenges with payer payments only exacerbate these issues. According to a Kaufman Hall report, 73% of leaders surveyed said claims denials, which was the top revenue cycle issue in 2022, had increased in 2023.
The cost of denials is staggering. A recent data analysis revealed that providers spent nearly $20
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Ensemble Health Partners, Microsoft Strengthens AI-Powered Revenue Cycle Management with Expanded Partnership
What You Should Know:
- Ensemble Health Partners, a provider of end-to-end revenue cycle outsourcing (RCM) for healthcare organizations, has announced a significant expansion of its partnership with Microsoft.
- The strategic collaboration aims to accelerate the development and adoption of Ensemble's industry-leading revenue cycle intelligence platform, EIQ®.
EIQ®: Powering AI-Driven Revenue Cycle Management
EIQ® is a powerful platform that leverages Microsoft Azure's
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Humana Expands Use of Cohere Health’s Prior Authorization Platform
What You Should Know:
- Cohere Health, a recognized leader in clinical intelligence and prior authorization automation, announced that Humana Inc. (NYSE: HUM) will expand its use of Cohere's prior authorization platform for diagnostic imaging and sleep services.
- In January 2021, Cohere and Humana began a pilot
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Putting 2024’s Split/Shared Services Billing Regulations into Practice
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)
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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
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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
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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
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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
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