Private equity is gaining a foothold in healthcare despite growing evidence that its role has been detrimental to care quality and prices. But new data and even governmental concern aren't slowing private equity investments in provider...
While value-based care adoption has accelerated in the healthcare industry, the alternative care delivery and payment model is still lacking in the pediatric setting. The current healthcare infrastructure does not support the resources...
Every penny counts when you are an independent physician-owned practice, according to Melissa Huff, CIO of the Clinics of North Texas.
Founded over 100 years ago, the Clinics of North Texas is a multispecialty network of more than 30...
Digital transformation is taking UnityPoint Health’s revenue cycle system from automation to machine learning in order to drive efficiencies and capture value.
The non-profit health system consisting of 17 regional hospitals, 19...
After an unprecedented three years, it’s time to return to the basics, according to Jordan Kearney, partner at Hooper, Lundy, and Bookman and founder of the firm’s Medicare Audits and Appeals Practice Group. By that, she means...
The US government could run out of money by next month if lawmakers cannot agree on raising or suspending the country’s debt limit. This economic catastrophe could leave the US without funds to pay its bills, and healthcare providers...
Kaiser Permanente’s plans to acquire Geisinger Health have opened the door to new value-based opportunities. Specifically, the proposed acquisition has the potential to create an accelerated path to value-based care and lead to...
As value-based care becomes the end goal for many healthcare organizations, health systems across the country are acquiring primary care practices to achieve this mission.
Critical aspects of these acquisitions include ensuring that...
CMS has released its 2024 Medicare Advantage (MA) and Part D Final Rule, which finalized policies on marketing oversight, prescription drugs, and prior authorization processes. Changes to prior authorization policies are particularly...
Nurses are unhappy, and they are letting hospital operators know it.
Nurse burnout, clinician shortages, compensation disputes, and the lingering effects of a global pandemic have made the nurse experience unbearable for many...
Nearly a year since the federal government launched the independent dispute resolution (IDR) process, Becky Greenfield, partner at Wolfe Pincavage, has learned a few things about the No Surprises Act (NSA) and out-of-network claim...
Long-term care residents are historically overlooked and require high-cost, complex healthcare services. Accountable care organizations (ACOs) present an opportunity for providers to earn shared savings while improving care quality for...
Prior authorizations are one of the biggest impediments to treating patients, according to Claire Ernst, JD, director of government affairs at MGMA.
The Medical Group Management Association, or MGMA, is a trade group representing...
Given the opportunity, most providers would like to set prior authorizations on fire. One accountable care organization based in the Pacific Northwest is doing just that, in a sense, by leveraging a relatively new health data standard to...
Leveraging automation for revenue cycle management (RCM) processes can streamline tasks and improve efficiencies. Specifically, partnering with an EHR vendor helped Advocare, an independent physician-owned group practice, achieve $1...
The patient financial journey can be lengthy and confusing for consumers following a healthcare encounter, making it a critical area of improvement for providers and their revenue cycle management teams.
Streamlining the patient financial...
Accountable care is getting a makeover. For over a decade, the healthcare system has been making the shift to accountable care, or “the coordinated provision of patient services by healthcare providers and facilities with the goals...
Value-based payment levels barely moved in 2021, with some movement in the downside financial risk category, according to the latest data from the Health Care Payment Learning and Action Network (HCP LAN).
The majority of healthcare...
The US healthcare system has a waste problem. Recent research published in JAMA confirmed that about a quarter of healthcare spending in the country can be attributed to waste, with wasteful spending totaling up to $935 billion.
Waste is...
The revenue cycle management department at MainStreet Family Care in Alabama has a mission, and that is to give patients every opportunity to pay their financial responsibility.
“We give the patient every opportunity that we can and...
