A recent report from the HHS Office of the Inspector General (OIG) turned heads across the healthcare industry after pointing to a notable rise in inpatient hospital stays where upcoding was believed to be the culprit. Compliance professionals who have been in the healthcare industry any length of time know what's next: targeted billing reviews by the Centers for Medicare and Medicaid Services (CMS) around hospital stays that are vulnerable to upcoding.
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Revenue Cycle Management | News, Analysis, Insights - HIT Consultant
3 Ways Real-Time ADT Notifications Will Benefit Payers’ Businesses
Payers and providers share goals around emerging healthcare delivery models such as value-based care and accountable care organizations (ACOs). But inadequacies in current payer/provider communication often disrupt the flow of timely care and lead to unnecessary hospital readmissions and poor outcomes. What’s needed in this partnership is the standardized, fluid, real-time exchange of data to help both parties become even more efficient and effective at providing members the proper care at the
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Revenue Cycle Management Can Help Advance The Cybersecurity Mandate
Holding steady in the No. 1 spot, the healthcare industry has held the top rank in IBM’s Cost of Data Breach report for the past 11 years. It’s a lead that seems secure. In just a year from 2020-2021, the average total cost for healthcare for an event increased 29.5%, and now sits at $9.23 million.
Even amidst that threat landscape, the percentage those in the healthcare space spend on cybersecurity hasn’t climbed out of the single digits. Only 6% or less of the IT budget is typically
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R1 Acquires Revenue Cycle Company Cloudmed for $4.1B
What You Should Know:
- R1, a leading provider of technology-driven solutions that reduce friction in healthcare, has just acquired CloudMed, a leader in Revenue Intelligence™ for healthcare providers in a $4.1B cash deal.
- Upon closing of the transaction, current R1 shareholders will own approximately 70% of the combined company on a fully diluted basis and Cloudmed equity holders will own approximately 30%. Cloudmed equity holders will enter into an 18-month lockup agreement, subject to
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What Are Digital Wallets and What Do They Mean for Healthcare?
Digital wallets are a payment option that continues to gain traction among consumers due to their simplicity and ease. Many providers, however, may be unfamiliar with the technology and how it can benefit their practices and patients.
At the most basic level, a digital wallet is a digital, mobile version of patients’ financial accounts that is easily accessible via a computer or smartphone, eliminating much of the need to carry an actual wallet. Digital wallets can be used by consumers
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AccessOne Acquires CueSquared to Address Patient Financial Experience
What You Should Know:
- AccessOne acquires one-touch mobile payment platform CueSquared. The acquisition adds mobile billing and payment product to existing patient financing offerings, extending AccessOne solution portfolio to address the overall patient financial experience.
AccessOne, a leading provider of inclusive Care Now, Pay Later patient financing solutions that help all consumers manage their healthcare costs, today announced that it has acquired CueSquared, a
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Complex Claims Vendor Argos Health Merges with EnableComp
What You Should Know:
- Argos Health ("Argos"), a rapidly growing provider of complex claims solutions to the country's leading healthcare providers announced today it has merged with EnableComp. Argos Health is.
- Argos works with hospitals, health systems, and physician groups to increase revenue recovery across workers' compensation, motor vehicle accident, out-of-state Medicaid, and Veterans Affairs claims, as well as ERISA appeals. Welsh, Carson, Anderson & Stowe ("WCAS") acquired
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Health Systems Cite Telehealth as Top Tool to Improve Patient Access in 2022
What You Should Know:
- Improving patient access to medical services is a top priority for health system leaders in 2022, according to new research from the Center for Connected Medicine (CCM) and KLAS Research.
- According to new research, patient access was identified by health system leaders as the challenge in healthcare that can be best addressed with telehealth in the coming year.
Nearly 99% of health systems identified improving patient access as a “high” or “very high”
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Medical Bills Continue to Plague Consumers as Source of Anxiety, Mystery and Frustration
What You Should Know:
- More than half (55%) of consumers find it stressful paying a medical bill, understanding their plan's coverage and benefits (53%) or comprehending what they owe (53%), according to results of Cedar’s Annual Healthcare Consumer Experience Study.
- 4 in 10 (41%) are unsatisfied with their billing experiences, and nearly 90% of consumers would find it at least "somewhat useful" if their healthcare provider posted pricing information on their website around expected
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Prior Authorizations: 3 Ways to Reduce Administrative Burden & Burnout
Medicare’s annual enrollment period has started, and you know what that means: a slew of commercials suddenly appearing on television for Medicare Advantage plans.
The advertising appears to be working. Enrollment in Medicare Advantage has more than doubled over the past decade to more than 26 million people this year. The private health plans, which are an alternative to traditional Medicare, account for 42% of the total Medicare population.
The growth of Medicare Advantage, though, has
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