While AI has the potential to streamline processes, its current use in the revenue cycle is resulting in more claim denials, payment delays, and a greater need for appeals, particularly because payers often use AI to retroactively review medical necessity determinations.
Sluggish margins and high costs have created a challenging environment for provider organizations. With the number of denied claims increasing significantly over the past few years, so has the time and resources needed to manage those denials.
The progress in artificial intelligence (AI) is reshaping patient care, across various dimensions, from facilitating faster discharge to curating treatment plans and suggesting lifestyle changes.
Three ways healthcare organizations can benefit from leveraging qualified revenue integrity professionals to enhance CDM technology and drive additional ROI
Hospitals’ operating margins and patient volumes dropped slightly in March. While hospitals were doing relatively well financially during the first quarter of the year, this new data could suggest more financial challenges ahead for hospitals. But right now, it’s unclear whether the recent declines in hospitals’ margins and volumes will be short- or long-term.
Improving encounter processing and reporting can safeguard and maximize revenue and operating margins providing the financial resources for payers to continue providing members with quality, life-enhancing healthcare.
A new study from Bessemer Venture Partners analyzed more than 100 venture-backed healthcare companies to determine the best strategies to scale to $100 million in annual recurring revenue. The report laid out a few main lessons health tech companies should know, such as the importance of nurturing relationships with early customers and making sure efficiency metrics are paid close attention.
As technology advances, AI-powered tools will increasingly reduce the administrative burdens on healthcare providers.
The company, which provides revenue cycle management solutions for providers, is filing for the IPO less than two years after Bon Secours Mercy Health sold its majority stake in Ensemble to private equity firm Golden Gate Capital. Per the filing, the company aims to raise $100 million, but that is likely a placeholder figure.
Hospital revenues and volumes are on an upswing, but growing expenses are still offsetting gains in these areas, especially as cases caused by the Delta Covid-19 variant continue to rise.
Though there has been a slew of failed merger plans in recent months, providers' interest in consolidation has not ebbed. Midwest-based Beaumont Health and Spectrum Health announced they are exploring a merger, as did Rush Health Systems and Ochsner Health, which are located in the South.
Bright Health has filed preliminary paperwork for an IPO, joining its rivals in the insurance technology space in going public. Though there are few confirmed details at the moment, Bright Health is reportedly looking to raise $1 billion through the offering.
The future looks bright for the integrated specialty pharmacy model – for health systems, providers, and most importantly, for patients.
According to a survey conducted by Catalyst @ Health 2.0, a whopping 41% of digital health companies said their revenue was above expectations last year. Despite reporting longer sales cycles, most companies still were optimistic about their business prospects going into 2021.
Hospital operating margins increased from January to March, but are still narrow, leaving hospitals in a financially vulnerable state, a new report from Kaufman Hall shows. In addition, volumes are still down and expenses continue to rise.
A new report from Kaufman Hall examines two potential financial situations for hospitals in 2021 — one optimistic, and the other bleak. Hospitals could lose between $53 billion and $122 billion depending on which scenario plays out.
As a result of rapid consolidation, the 10 biggest health systems controlled 24% of market share based on patient revenue by 2018. The trend is expected to continue through the next decade, with health systems facing growing financial pressures and an increase in demand for new types of care delivery.
Hospitals and physician practices are struggling to regain firm financial footing, and though there have been some recoveries, the landscape continues to be uncertain for these entities, according to reports from healthcare consultancy Kaufman Hall.