The Centers for Medicare & Medicaid Services (CMS) recently proposed a new rule to advance interoperability and improve the prior authorization (PA) process for Medicare and Medicaid patients. Specifically, the rule stipulates that health plans adopt electronic prior authorization processes, adhere to shorter turnaround times, clearly communicate denial reasons, publish key metrics annually, and implement the Fast Healthcare Interoperability Resources (FHIR) Application Programming Interface
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Revenue Cycle Management | News, Analysis, Insights - HIT Consultant
KLAS Report Reveals Key Challenges from Provider Organizations
What You Should Know:
- In September 2022, KLAS hosted the sixth annual Digital Health Investment Symposium (DHIS). Executives from healthcare provider organizations, HIT companies, investors, and innovators came together to collaborate on important developments in healthcare technology.
- Drawing on insights from a pre-summit survey as well as insights shared at the summit in small-group discussions, KLAS published a white paper highlighting core challenges identified by summit
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5 Must-Have Features for AI Platforms in RCM
A healthy, stable revenue cycle is crucial to every healthcare organization’s success. However, managing the revenue cycle takes experienced coders, complete documentation, and timely resolution of denials.
Administrative processes account for about 30% of U.S. healthcare costs, which means that all areas of a patient encounter, from check-in to billing and claims, are potential targets to obtain greater efficiency.
In the past 20 years or so, computer-assisted coding (CAC) has become
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Edifecs and VirtualHealth Partner to Automate Prior Authorization
What You Should Know:
- Today, Edifecs and VirtualHealth, a medical management company, announced a new partnership automated prior authorization to VirtualHealth’s HELIOS® platform for healthcare payer and provider clients.
- The Edifecs solution will automate and optimize the prior authorization process across HELIOS to significantly reduce the administrative burden, alleviate friction between payers and providers, and ultimately expedite patient care.
Growing Need for Automated Prior
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Half of the Patients With High-Deductible Health Plans Have Received Surprise Medical Bills
What You Should Know:
- AKASA™, the leading developer of AI for healthcare operations, released findings from a survey conducted on its behalf by YouGov.
- The findings highlight how patients with high-deductible health plans (HDHPs) suffer the downstream effects of a complex medical billing process, including surprise medical bills, inaccuThe findings highlight how patients with high-deductible health plans (HDHPs) suffer the downstream effects of a complex medical billing process,
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9 Executive Revenue Cycle Predictions/Trends to Watch in 2023
Nate Maslak, the co-founder/CEO of Ribbon Health
Price Transparency: In 2022, we saw CMS’s Transparency in Coverage rule go into effect, requiring non-hospital entities like health plans and providers to publish publicly available rates for care. In 2023, we’ll see this price transparency data become more mainstream as it finally makes its way into the hands of patients, empowering them to find the best care for them, reevaluate their care choices, and shop around for the best possible care
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43% of Consumers Spend Up To A Month Correcting Billing Errors
What You Should Know:
- In the online survey administered to 800 U.S. consumers who had found at least one medical billing error in the last five years, 41% of the consumers are significantly frustrated trying to address billing errors.
- Zelis, a company modernizing the business of healthcare, announced findings from a new study on consumer billing conducted in partnership with Hanover Research, an independent research firm. The full results and insights are featured in the
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M&A: Alpine Investors Acquires RCM Services Provider Medusind
What You Should Know:
- Alpine Investors, a people-driven private equity fund, announced that it has acquired Medusind, a provider of revenue cycle management services to the healthcare industry.
- Jose Rivero, an Alpine CEO-in-Residence and part of the firm’s PeopleFirst program, has assumed the role of CEO of Medusind. Terms of the private transaction were not disclosed.
Medusind Background
Founded in 2002, Medusind provides deep expertise and powerful revenue cycle
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The Future of Digital Payment Trends in Healthcare to Watch
Staffing shortages, cost of care delivery and reimbursement changes have put more pressure on healthcare practices to do more with less. Recent technology advancements have come to the rescue and enabled healthcare organizations to simplify processes, improve communication efforts and ultimately support staff and patients alike.
Patient payment tools are an example of a technology solution that has been around for years but has not been widely adopted. However, as technology has
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Edifecs and 3M Partner on Integrated Value-Based Payment Solution
What You Should Know:
- 3M Health Information Systems and Edifecs (a global health IT solutions provider) announced a collaboration and new unique solution for providers and payers that will accelerate the adoption of value-based payment (VBP) models.
- A new, combined solution that will overcome barriers that have previously prevented rapid adoption of VBP models. This advanced approach will allow payers and providers to quantify the value of preventing negative events and allocate
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