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
Read More
Revenue Cycle Management | News, Analysis, Insights - HIT Consultant
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
Read More
HPS/PayMedix Acquires TempoPay to Simply Healthcare Payments
What You Should Know:
- HPS/PayMedix, a leading provider of healthcare financing solutions, announced the acquisition of TempoPay, an innovative payments platform designed to help employees manage healthcare costs. Financial details of the acquisition were not disclosed.
- The acquisition of TempoPay is a significant step forward in addressing the healthcare affordability crisis. By providing employees with the financial tools and support they need, HPS/PayMedix is helping to
Read More
7 Strategies to Modernize The Healthcare Payment Ecosystem
Submitting and paying claims is the financial underpinning of the U.S. healthcare system, a system plagued with inefficiencies that create disconnects between health plans and health systems. As a result, revenue cycles and claims systems are clogged, the patient and member experience is disrupted, care quality is suffering, and innovations in care delivery are constrained.
The solution? Modernization.
Modernizing the healthcare ecosystem reduces wasteful administrative
Read More
R1 RCM to Be Acquired by TowerBrook and CD&R for $8.9B
What You Should Know:
- R1 RCM Inc., a leading provider of technology-driven healthcare revenue cycle management solutions, announced that it has entered into a definitive agreement to be acquired by investment funds affiliated with TowerBrook Capital Partners and Clayton, Dubilier & Rice (CD&R). The all-cash transaction values R1 at approximately $8.9 billion.
- Under the terms of the agreement, TowerBrook and CD&R will acquire all outstanding shares of R1
Read More
How EHRs Should Help not Hurt Health System Finances
Hospitals and health systems continue to face persistent challenges from rising costs and labor shortages across clinical, administrative and revenue cycle teams. Recent news from Humana highlights that rising costs, “may persist for an extended period or, in some cases, permanently reset the baseline.” In addition, half of hospitals and health systems surveyed reported $100 million in Accounts Receivable (AR) for claims older than 6 months, amounting to $6.4 billion in delayed or unpaid claims,
Read More
Thoughtful AI Secures $20M, Launches Human-Capable RCM AI Agents
What You Should Know:
- Thoughtful AI, a provider of AI-powered revenue cycle automation (RCM), has announced a series of exciting developments, including the launch of the world's first fully human-capable AI Agents for healthcare RCM, exceptional growth metrics, and $20 million in Series A funding.
- Thoughtful AI's groundbreaking AI Agents, CAM, EVA, and PHIL, are tackling the burden of repetitive RCM tasks like claims processing, patient eligibility verification, and payment
Read More
Med-Metrix Acquires HRSI to Strengthen Eligibility Management Capabilities
What You Should Know:
- Med-Metrix, LLC (“Med-Metrix”), a leading provider of technology-enabled Revenue Cycle Management (RCM) solutions acquires Healthcare Receivable Specialists, Inc. (“HRSI”). HRSI is a specialized RCM and patient access company with a strong reputation for its best-in-class Medicaid eligibility services.
- The strategic acquisition strengthens Med-Metrix’s position as a comprehensive RCM provider by adding HRSI’s expertise in eligibility management. Financial
Read More
Regard Secures $61M for AI-Powered Clinical Insights Platform
What You Should Know:
- Regard, an AI-powered clinical insights platform raises $61M in Series B funding led by Oak HC/FT with participation from prominent healthcare and technology investors.
- The investment will fuel the company's mission to unlock the full potential of patient data for improved clinical care.
Untapped Potential in Healthcare Data
The healthcare industry is experiencing a data deluge. New technologies generate mountains of patient information, but a
Read More
Carilion Clinic Selects Ensemble Health to Outsource Revenue Cycle Operations
What You Should Know:
- Carilion Clinic, a Roanoke-based non-profit health system that owns and operates several hospitals in western Virginia -- announced it has selected end-to-end revenue cycle management (RCM) provider Ensemble Health Partners as its strategic end-to-end RCM partner.
- Carilion chose Ensemble for its proven track record of quickly delivering value and sustaining high performance. Notably, Ensemble has consistently met 100% of year-one client goals, exceeded 102%
Read More
