Current billing practices do not adequately meet the needs of consumers, providers or payers. While there is no magic wand, reinventing billing processes in the US will require measures that strengthen consumer protection, and continued policy change towards fairer drug pricing and increased price transparency of provider service costs.
CodaMetrix, an AI platform for hospital revenue cycle management, recently closed a $55 million Series A funding round. The company, which was launched out of Mass General Brigham in 2019, is focused on simplifying the complicated process of translating patient records into codes for billing and clinical research.
Elation Health announced its acquisition of medical billing company Lightning MD — a deal the company made to help it become an all-in-one technology platform for primary care providers. Lightning MD stood out from other medical billing startups because of its ease of use, Elation CEO Kyna Fong said.
The lawsuit is one of nine cases throughout the country that TeamHealth has brought against United for alleged underpayments. The other eight cases are still ongoing.
A transformation is underway in medical coding as automation permeates revenue cycle management, raising questions such as: How will automation affect how medical coders work? How advanced is coding automation currently? What kind of skill sets will be needed for these new types of coding?
Patients deserve high-quality care and better outcomes, as well as equitable, consistent and transparent billing experiences. So how do we get there?
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
When designed effectively, digital payment and financial communications can have a substantial impact on a hospital or health system’s bottom line. But patients still commonly receive their bills by mail.
Betty Chow, a Los Angeles resident, had a cervical disc replaced in August 2020 at a surgery center that was part of her Anthem Blue Cross PPO network. Thirteen months later, she was blindsided by a bill for nearly $2,000 from the anesthesiologist who was on her surgical team but was not contracted with her […]
The deadline to comply with the No Surprises - January 1 - is practically around the corner. Payers that want to be in compliance with its provider directory provision must act now.
Historically, providers had to meet certain criteria and address three key areas in the patient’s progress notes: patient history, physical exam and medical decision making. CMS has eliminated the history and exam components as required elements for billing purposes, so medical decision making is now the sole driver of the level-of-service.
Munck Wilson Mandala Partner Greg Howison shared his perspective on some of the legal ramifications around AI, IP, connected devices and the data they generate, in response to emailed questions.
Vivor CEO and Co-founder Ian Manners talks about the origins of the financial assistance startup and their mission to eliminate out-of-pocket costs as a barrier to care.
Our weekly cartoon takes a look what hospitals do in trying to recover unpaid bills.
Digitizing and automating what can be an inefficient process is the kind of low-hanging fruit that many startups target. Revenue cycle management offers fertile ground for those purposes.
Consumers need dynamic pricing, where cost can be lowered based on good behavior, for medications and services that are financially out of reach.
Streamlining patient registration, offering more financial services and protecting patients from unexpected medical bills are proven ways to collect more revenue, improve cash flow and reduce bad debt.
