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