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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Revenue Cycle Management | News, Analysis, Insights - HIT Consultant
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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Physician Practices Struggle After Change Healthcare Cyberattack: Unpaid Claims, Staff Strain, and Potential Closures
What You Should Know:
- A recent American Medical Association (AMA) survey reveals the ongoing crippling effects of the Change Healthcare cyberattack on physician practices across the United States.
- The survey was conducted after UnitedHealth Group (UHG) said that claims would be flowing by the weekend of March 23. Despite UHG’s assurances, the attack, which began in February 2024, has disrupted claim processing and caused significant financial strain, jeopardizing patient
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Availity Launches AI-Powered Claims Denial Prediction Tool
What You Should Know:
- Availity, a real-time health information network launches Predictive Editing, a revolutionary feature within its Availity Essentials Pro™ platform.
- The AI-powered tool developed in partnership with Anomaly Insights empowers healthcare providers to significantly reduce claim denials, leading to smoother revenue cycle management and improved financial performance.
The Problem: Costly Claim Denials
Denied claims are a major pain point for healthcare
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