Tag: Healthcare RCM Outsourcing

failing on prior auth reform

Health Insurance Industry Is Failing on Prior Authorization Reform

In theory, prior authorization (PA) exists to ensure that healthcare services are medically necessary and cost-effective. But in practice, it has become a bureaucratic roadblock causing treatment delays, administrative overload, and provider burnout. Despite increasing pressure from physicians, hospitals, patient advocacy groups, and even bipartisan lawmakers, the health insurance industry failing on prior authorization reform […]
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Addressing Common Pain Points in RCM And How Outsourcing Alleviate It?

Addressing Common Pain Points in RCM And How Outsourcing Alleviate It?

Revenue cycle management (RCM) is an intricate and critical aspect of the healthcare industry, encompassing the entire process from patient registration to reimbursement. However, RCM processes often face challenges, leading to pain points that can hinder efficiency, increase costs, and negatively impact patient satisfaction. Outsourcing Revenue cycle management services offers a viable solution to alleviate […]
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Why Medicare’s trustees say the physician pay system is unsustainable

Why Medicare’s trustees say the physician pay system is unsustainable

Medicare’s trustees have issued a report (PDF) that reckons with the consequences that patients could face as a result of the physician payment system’s long-term unsustainability. Your Powerful Ally The AMA helps physicians build a better future for medicine, advocating in the courts and on the Hill to remove obstacles to patient care and confront […]
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How Medicare Out-of-Pocket Healthcare Spending Cap May Impact Beneficiaries

How Medicare Out-of-Pocket Healthcare Spending Cap May Impact Beneficiaries

A Medicare out-of-pocket healthcare spending cap could halve out-of-pocket spending for beneficiaries, but could boost overall traditional Medicare spending. By implementing a $5,000 spending cap in traditional Medicare, policymakers might be able to halve out-of-pocket healthcare spending for high-spending Medicare beneficiaries, but they risk an increase in overall Medicare spending, a study from Urban Institute […]
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Healthcare spending could drop $11.4B next year if ACA premium subsidies expire, research finds

Healthcare spending could drop $11.4B next year if ACA premium subsidies expire, research finds

Healthcare spending could drop by more than $11.4 billion next year if enhanced premium tax credits enacted in the American Rescue Plan expire, new research finds. Hospital spending would decline by $3.8 billion, while spending on physician practice services would drop by $1.3 billion, according to a report from the Robert Wood Johnson Foundation and […]
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Healthcare Finance Leaders Facing Revenue Cycle Workforce Shortages

Healthcare Finance Leaders Facing Revenue Cycle Workforce Shortages

More than 400 healthcare finance leaders reported having revenue cycle workforce shortages, with almost 20 percent seeing 30 or more vacancies. Healthcare finance leaders are experiencing revenue cycle workforce shortages, with one in four reporting that they need to hire more than 20 employees to fully staff their department, according to a survey commissioned by […]
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Medicare advantage prior authorizations are often unnecessarily denied

Medicare advantage prior authorizations are often unnecessarily denied

  A report by the Office of Inspector General (OIG) raises concerns about organizations prioritizing profits over patient access to care. Medicare Advantage organizations (MAOs) often delay or deny services for medically necessary care, even when prior authorization requests meet coverage rules, according to a report by the OIG. A concern with the Medicare Advantage […]
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Government Accountability Office asks CMS to assess telehealth quality for Medicaid beneficiaries

Government Accountability Office asks CMS to assess telehealth quality for Medicaid beneficiaries

The U.S. Government Accountability Office is asking the Centers for Medicare and Medicaid Services to gauge the effect that an increase in telehealth utilization is having on the care quality experienced by Medicaid beneficiaries. The GAO cited statistics showing usage continues to rise. GAO culled data from five states – Arizona, California, Maine, Mississippi and […]
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