Revenue Cycle Management Healthcare News

Independent Dispute Resolution Case Load 14X More Than Expected

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Nearly a year after the federal government launched the independent dispute resolution (IDR) process under the No Surprises Act, over 330,000 balance billing disputes have been filed, nearly 14 times...

AMGA: Pharmacy Claims Data Key to Value-Based Care Progress

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Lawmakers have their eyes on pharmacy benefit manager (PBM) reform, but one bill is looking to take it a step further by requiring commercial payers to share pharmacy claims data with providers to...

What the End of the COVID-19 PHE Means for Healthcare Providers

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The COVID-19 public health emergency (PHE) has officially ended, and with it, so have policies that helped healthcare providers navigate challenging circumstances, including provider relief funds and...

Hospital Revenue Growth Outpaced Rising Expenses in March

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Revenue growth exceeded expense increases in March 2023, resulting in positive hospital operating margins for the first time in 15 months, according to a report from Syntellis Performance...

MGMA: Medicare Advantage Growth Exacerbates Prior Authorization Burdens

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As Medicare Advantage enrollment grows, medical practices are experiencing more prior authorization burdens, including higher administration costs and disrupted workflows, a report from the Medical...

CFPB Report Identifies Pitfalls of Medical Credit Cards, Loans

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In the age of high deductibles, providers are increasingly turning to financial institutions and fintech companies to offer medical credit cards and installment loans to their patients. However, a new...

Hospital-Physician Integration Leads to More Intense Cardiac Care

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Patients who see cardiologists employed by hospitals are significantly more likely to receive high-intensity, hospital-based coronary interventions compared to patients who see independent doctors,...

340B Drug Pricing Program Eligibility Tied to Lower Biosimilar Use

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Participation in the 340B drug pricing program was associated with reduced biosimilar use and more biologic administrations, a study published in Health Affairs found. The 340B program allows eligible...

Razor Thin Margins Leave Hospitals Vulnerable to a Recession

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Hospital operating margins are stabilizing after a turbulent couple of years. However, margins remain below pre-pandemic levels, which makes hospitals and health systems vulnerable to a possible...

Benchmark Regionalization in MSSP Disincentivized Higher-Spending ACOs

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After CMS began incorporating regional spending into accountable care organization (ACO) benchmarks in the Medicare Shared Savings Program (MSSP), more higher-spending ACOs exited the program, a study...

Health Disparities in Heart Failure Admissions Cost Over $60M

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Health inequity is costing the Medicare program more than $60 million on preventable heart failure hospital admissions, suggests a new study out of Tulane University. The study published in the most...

Private Equity Firms Acquired Over 700 Oncology Practices in 20 Years

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Private equity acquisition of oncology practices has grown in the past two decades, with over 700 clinics becoming affiliated with a private equity firm between 2003 and 2022, a study published in JAMA...

HHS to Start Unwinding COVID-19 Vaccine Requirement

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HHS and DHS are starting the process of ending the COVID-19 vaccine requirement for CMS-certified healthcare facilities, as well as Head Start educators and certain noncitizens at the borders. The...

Provider Groups Band Together to End Cigna’s Modifier 25 Policy

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The American Medical Association (AMA) and more than 100 other provider trade associations have taken issue with a new policy from The Cigna Group regarding claims with modifier 25. Cigna recently...

Intermountain Taps Surgery Partners to Manage, Grow ASCs

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Intermountain Health recently announced it signed a collaborative agreement for Tennessee-based Surgery Partners to take over management of its ambulatory surgery centers (ASCs) in certain markets...

Skilled Nursing Facility Use Increased Following PHE Waiver

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Skilled nursing facility (SNF) episodes for Medicare beneficiaries without preceding acute care increased during the COVID-19 public health emergency (PHE), a study published in JAMA Internal Medicine...

Kaiser Permanente to Acquire Geisinger, Expand Value-Based Care

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California-based integrated health system Kaiser Permanente recently announced that it has agreed to acquire Geisinger Health, a 10-hospital system on the East Coast, in an effort to develop a new...

CMS Cracks Down on Hospital Price Transparency Compliance

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CMS is cracking down on hospital price transparency compliance — or lack thereof. The federal agency announced yesterday updated enforcement procedures, including earlier and automatic civil...

Less than Half of Primary Care Physicians Participate in Value-Based Care

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Value-based care participation is lacking among primary care physicians; most practices reported receiving fee-for-service payments in 2022, according to data from the Commonwealth Fund. Value-based...

Nonprofit Hospitals Rely on Financial Reserves Amid Operational Challenges

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Financial reserves have helped nonprofit hospitals and health systems survive amid ongoing operational and economic challenges, according to a report prepared for the American Hospital Association...