Tag: Healthcare RCM


Significance of Medical Coding Strategies

Medical coding strategies contribute various benefits, counting cost reduction and control, systematic healthcare management, and increased scalability. Compliance with medical coding qualities also promises patients’ data privacy and security and alleviates the threats of audits. In the current healthcare landscape, keeping up financial solidity has become progressively hard due to the shift from fee-for-service to […]
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Hospital Expenses Have Increased 23 Percent Since 2016

Supply chain issues, medication costs, and labor challenges sparked by the COVID-19 pandemic have contributed to the spiking hospital expenses. Hospital expenses have increased 23 percent since 2016, a spike researchers attributed to continuous COVID-19 challenges, according to a recent analysis. By analyzing American Hospital Association data, investigators noticed hospital expenses increased 47 percent in 2020when […]
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How physicians can untangle the web of relationships essential for value-based care success

Primary care physicians (PCPs) and other physicians continue to migrate away from the traditional fee-for-service (FFS) reimbursement model toward value-based and risk-bearing care models that reward better outcomes and reduced healthcare costs. Value-based care (VBC) contracts are projected by McKinsey to cover nearly 65 million Americans, or 22% of insured lives, by 2025, up from […]
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CMS Issues Contract Year 2023 Final Rule for Medicare Advantage Organizations and Prescription Drug Sponsors

On April 29, 2022, the Centers for Medicare and Medicaid Services (“CMS”), issued the final rule on Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs (the “Final Rule”).  CMS promotes the Final Rule as advancing “CMS’ strategic vision of expanding access to affordable health care and […]
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What is the HIPAA Security Rule?

The HIPAA Security Rule requires covered entities and business associates to implement technical, physical, and administrative safeguards. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) required the HHS secretary to develop rules for safeguarding electronic protected health information (ePHI). Out of these requirements, HHS created the HIPAA Privacy Rule and the HIPAA Security […]
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Role of Health Insurance Coverage, Benefits in Great Resignation

The Great Resignation forced employers to focus on how they can improve healthcare benefits to retain talent, but employers and employees have differing opinions on healthcare coverage. As the Great Resignation sweeps across the US, employers and their human resource teams are often misaligned with employees regarding health insurance coverage and the role healthcare benefits […]
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13 recent CMS actions

CMS recently released new data on hospital changes of ownership, a health equity plan and said it would end a legal battle with Texas over Medicaid. Becker’s has reported on the following 13 CMS moves since April 8. Finance No hospitals received price transparency notices in April, CMS says CMS issued no additional warning notices […]
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Bridge the gaps between payer and provider by automating your revenue cycle

The health care industry is rapidly evolving. COVID-19 has uncovered a litany of flaws in health care systems, leading to massive changes in the way patients, providers, and payers communicate and operate. One of the highest impact changes in the industry is the widespread shift from a traditional fee-for-service reimbursement system to value-based care. Instead […]
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CMS, HHS Finalize 2023 Notice of Benefits, Payment Parameters

CMS and the Department of Health and Human Services (HHS) released the 2023 Notice of Benefits and Payment Parameters Final Rule, which includes standardized plan options, changes to network adequacy reviews, refinements to the Affordable Care Act’s essential health benefits nondiscrimination policy, and other changes. “The recent Open Enrollment Period demonstrated the demand for high-quality, […]
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