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Revenue Cycle Management | News, Analysis, Insights - HIT Consultant

Q/A: Experian Health’s CPO Talks State of Patient Access

by Syed Hamza Sohail 06/19/2024 Leave a Comment

Q/A: Experian Health’s CPO Talks Patient Access & the Health-Tech Nexus

Experian Health, a provider of solutions in revenue cycle management, identity management, patient engagement, and care management, plays a pivotal role in transforming the healthcare landscape. By leveraging advanced data analytics and innovative technology, Experian Health aids healthcare organizations in improving operational efficiency and enhancing patient access to care. The company has just released its annual “State of Patient Access Survey,” which reveals a notable shift from last
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How AI Can Increase the Success of Clinical Denials Appeals

by Steve Albert, EVP and Chief Product Officer, R1 06/05/2024 Leave a Comment

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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Evolent Acquires Machinify’s AI-Driven Medical Authorization Solution

by Fred Pennic 06/04/2024 Leave a Comment

Evolent Acquires Machinify's AI-Driven Medical Authorization Solution

- Evolent Health, Inc. (NYSE: EVH), a leader in improving health outcomes for patients with complex conditions, announced today an agreement to acquire key assets from Machinify, including the exclusive license to their AI-powered platform, Machinify Auth.  - Additionally, certain Machinify employees will join Evolent. Both companies plan to establish a long-term services agreement to ensure smooth integration and ongoing platform development. This innovative technology aims to
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Hospitals See Strong Financial Performance in April, Despite Rising Expenses

by Fred Pennic 06/03/2024 Leave a Comment

Hospitals See Strong Financial Performance in April, Despite Rising Expenses

What You Should Know:  - U.S. hospitals and health systems continued to experience positive financial performance in April, with patient demand and revenues rising for the 12th consecutive month, according to new data from Strata Decision Technology. - While hospitals and health systems experienced positive financial performance in April, rising expenses remain a concern. Continued monitoring of these trends will be crucial for understanding the overall health of the healthcare
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SamaCare Secures $17M to Scale Specialty Drug Prior Authorization Platform

by Syed Hamza Sohail 05/21/2024 Leave a Comment

SamaCare Secures $17M to Scale Specialty Drug Prior Authorization Platform

What You Should Know: -              SamaCare, a cloud-based patient access platform for specialty medications, today announced that it has closed an oversubscribed $17 million Series B investment round led by new investor Questa Capital. -              Questa is joined in the round by existing investors Vive Collective and South Park Commons. SamaCare
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Daffodil Health Secures $4.6M for AI-Powered Healthcare Pricing & Admin Solution

by Fred Pennic 05/16/2024 Leave a Comment

Daffodil Health Secures $4.6M for AI-Powered Healthcare Pricing Solution

What You Should Know:  - Daffodil Health, a healthcare technology company, has secured $4.6M in seed funding to tackle the multi-billion dollar problem of wasted healthcare administrative costs led by Maverick Ventures with participation from Epic Ventures. - Daffodil Health is the brainchild of a team with over 100 years of combined experience in healthcare and technology, from companies like MultiPlan, Google, and McKinsey. They recognize the urgent need to overhaul the current
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SmarterDx Nabs $50M for AI-Powered Revenue Integrity for Hospitals

by Syed Hamza Sohail 05/14/2024 Leave a Comment

SmarterDx Nabs $50M for AI-Powered Revenue Integrity for Hospitals

What You Should Know: -              SmarterDx, the leader in clinical AI for revenue integrity and care quality, today announced it has secured $50 million in Series B funding led by Transformation Capital. -              The round also includes continued investments from Bessemer Venture Partners, Flare Capital Partners and Floodgate Fund, bringing total funding to $71 million to date. The investment will drive product
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Revenue Integrity in 2024: Reducing Leakage Points in a Complicated Cycle

by Tanya Sanderson, RN, BSN, MBA, MHA, CLNC, CHFP, Sr. Director of Revenue Integrity, Xsolis 05/14/2024 Leave a Comment

Revenue Integrity in 2024: Reducing Leakage Points in a Complicated Cycle

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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Firstsource Acquires Quintessence to Bolster AI-Powered Revenue Cycle Management Solutions

by Fred Pennic 05/03/2024 Leave a Comment

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

by Steve Albert, Executive Vice President and Chief Product Officer, R1 05/02/2024 Leave a Comment

Can AI 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
Read More

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