Insights

Payors adopting EPP are mainly prioritizing connectivity that meets their needs – gaining access to necessary clinical documentation and quality outcomes to adjust risk scores of beneficiaries (and associated government reimbursement) as well as enhance their rankings against other health plans.

Medicare reimbursement rates have never covered the total cost of care, so when MA reimbursement falls below that already-low baseline, hospitals are left to absorb the difference. With rising costs, record inflation and dwindling labor, many hospitals simply can’t afford to cover the difference anymore.

One common reason for health systems to exit a payor’s network is the inability to reach mutually agreed-upon reimbursement rates and terms during contract negotiations. Years of challenges with timeliness, accuracy and costs of pursuing full reimbursement from an insurance company often lead to this last-ditch effort.

Healthcare revenue cycle management (RCM) covers the business side of healthcare and includes all tasks associated with the management and collection of revenue generated by healthcare organizations from patient care episodes, from initial patient intake through complete payment collection.

It pays to be thoughtful about who you partner with. Here are 6 Tips to Ensure Your RCM Partnership Will Go the Distance.

For healthcare organizations, ensuring financial stability is crucial to providing high-quality care to patients. One key aspect of financial management in healthcare is the revenue cycle, which encompasses all aspects of the patient billing process, from insurance verification and pre-authorization to claims submission and payment posting. Effective revenue cycle management is essential to ensure accurate and timely reimbursement for

When it comes to revenue cycle management (RCM) outsourcing, the process of selecting the right partner for your organization’s financial success is crucial. In the ever-evolving healthcare landscape, managing revenue cycles efficiently has become more challenging than ever. Thanks to increasing complexities, stringent regulations and mounting administrative burdens, many healthcare providers are turning to outsourcing

The medical profession is one that requires face-to-face interactions with patients on a daily basis. However, it’s not just the physician who’s responsible for creating a positive patient experience. The medical organization itself has a lot to do with how satisfied patients are, including facilitating a positive patient experience. Healthcare organizations should strive to provide

As hospitals continue to face unprecedented levels of financial pressure, leaving money on the table isn’t an option. Yet too many hospitals continue to lose anywhere from 1% to 10% of net revenue on underpaid claims each year – money they are contractually owed.

With one in three hospitals expected to continue operating with a negative margin, leaving money on the table is not an option, but it’s a billion-dollar issue.