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