Features

Tech Worsened Nurse Burnout, Can a New Health IT Strategy Make it Right?

RevCycleIntelligence 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 healthcare professionals. This recently came to a head in New York City, where 7,000 nurses walked out of two prominent hospitals for a three-day nursing...


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How Walmart Became a Major Player in the Healthcare Industry

Walmart is no longer just a name in the retail world; the company made its move into the healthcare space in 2019 when it launched Walmart Health. Since then, Walmart Health has expanded its footprint of community health centers and...

Digging into CVS’ Latest Proposed Purchase: Oak Street Health

The latest debate in the healthcare merger and acquisition space surrounds healthcare giant CVS Health’s plans to acquire Oak Street Health for $10.6 billion. CVS, known for its pharmacy operations and health insurance plans, is...

Lessons from the NSA’s Independent Dispute Resolution (IDR) Process

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 disputes....

Long-Term Care ACOs Present an Opportunity for the Most Complex Populations

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 this...

From AI to Regulation, Making Progress with the Prior Authorization Process

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 practices...

How a Better Prior Authorization Process is Rising from FHIR

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...

The Most Successful Alternative Payment Models from CMMI, To Date

The Center for Medicare & Medicaid Innovation (CMMI) has launched more than 50 alternative payment and care delivery model tests, with 33 models now or still operational, according to CMMI’s sixth report to Congress on its...

How EHR-RCM Integration Can Improve Revenue Cycle Efficiency

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 billion...

Connecting Payers, Providers, and Tech for a Better Patient Financial Experience

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...

Key Plans for Advancing Accountable Care, Value-Based Payment

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 of...

Value-Based Payment, Fee-for-Service Levels Hold Steady

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...

How UT Health East Texas Addresses Healthcare’s Waste Problem

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 an...

Why Text-to-Pay is a Key Resource in the Patient Collections Toolbox

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...

Medical Coding is the Next Stop for Artificial Intelligence in Healthcare

To a layperson, medical codes look like a different language, and in a way they are. Medical coding is a highly complex process in healthcare in which clinicians and revenue cycle staff work together to translate clinical encounters into...

3 Trends from the Revenue Cycle Management Virtual Summit

Patient financial experience, denial prevention, and remote work are major challenges for healthcare organizations, according to healthcare leaders at this year’s Revenue Cycle Management Virtual Summit. The Summit took place on Sept....

4 Key Areas of Value-Based Care Transformation

Healthcare has a spending problem. For all the investments made in healthcare—$4.1 trillion to be exact—outcomes are not where they should be. In fact, the US has the lowest life expectancy compared to other high-income...

ACOs Improve Quality, Physician Burnout As New Opportunities Emerge

Accountable care organizations (ACOs) aim to improve healthcare quality for patients while reducing costs. Even as healthcare providers have operated in an unstable industry for the past few years, ACO programs have continued to achieve...

Healthcare Compliance Will Be a Challenge in Post-PHE World

The COVID-19 public health emergency (PHE) declaration was accompanied by several waivers and flexibilities that made it easier for healthcare providers to care for patients amid a global pandemic. Expanded telehealth coverage, Stark Law...

Predictive Analytics Streamline Hospital Operations at Seattle Children’s

There are several Seattle Children’s Hospitals. No, you can’t physically go to these other “hospitals” for world-class pediatric care, but the organizations are helping to make Seattle Children’s more...