The findings demonstrate a growing interest in digitally transforming outpatient RCM to improve efficiencies and optimize revenue. About 22% of revenue cycle leaders who manage their inpatient revenue cycle management already outsource some of their outpatient RCM, and 12% have ambitions to do so in the future, find a new survey conducted by the Healthcare […]
Payment integrity in Medicaid—the concerted effort to keep tight control over fraud, waste and abuse—can be addressed at any stage in the claim cycle. Of course, the earlier it is addressed, the easier it is for health plans to avoid improper payments and the administrative burden of recovering them. And while pre-payment integrity programs maximize […]
A focus on front-end revenue cycle efficiency can help to avoid costly medical necessity denials. KEY TAKEAWAYS Four words often describe the efforts to prevent denials related to medical necessity: too little, too late. Mistakes are made early in the patient’s hospital stay, and these mistakes lead to problems down the road. What remains constant […]
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 payment […]
The American Medical Association urged congressional leaders to lift the freeze on Medicare physician payments and provide updates that reflect inflation and practice costs. Following a recent Medicare Payment Advisory Commission (MedPAC) report, the American Medical Association (AMA) has asked Congress to update the Medicare physician payment system to include a stable annual payment rate […]
Through the online price transparency tool, users can view hospital service prices and assess machine-readable file completeness. A healthcare technology company has launched an online price transparency tool that allows consumers to compare hospital costs before seeking care. Turquoise Health’s Price Transparency Scorecard lets consumers find prices by searching for specific services or providers. The […]
CMS encouraged Medicare Advantage plans to waive prior authorizations during the public health emergency, but AHA urged the agency to make it a requirement instead of a suggestion. The American Hospital Association (AHA) has asked CMS to work with Congress and require Medicare Advantage plans to waive prior authorization processes during the current and future […]
Proper funding can help your practice to rise above some challenges. 9 Challenges funding can help your medical practice overcome Medical practice funding is often best used to support growth initiatives that will increase your practice’s revenue—thus increasing the chance that you’ll be able to pay off your loan on time. However, sometimes medical practices […]
While consumers wanted to see more transparency across the major healthcare stakeholders, they stressed the personal impact of insurance-related healthcare spending. Most Americans reported that health insurers are not successfully deflecting high healthcare spending and many survey respondents sought more transparency and out-of-pocket healthcare spending support around prescription drug spending, according to a survey from […]
Medicare Advantage plans expanded their supplemental benefits offerings in 2022, with more health plans offering special supplemental benefits for the chronically ill (SSBCI), according to an issue brief commissioned by Better Medicare Alliance. Medicare beneficiaries typically join Medicare Advantage plans because of the array of supplemental benefits that the program offers in addition to […]
