Medicare and RCM - Connected Health Pulse

Turning Increased Ambulatory Volumes into Financial Strength: 4 Moves for RCM

Healthcare IT Today

OCTOBER 23, 2023

For example, as outpatient services such as infusions outpace projections , and as the Centers for Medicare & Medicaid Services open the door to more outpatient procedures by moving 11 procedures off its “inpatient only” list, ambulatory providers must have the financial strength to make the investments needed to support growth.

RCM

RCM Patient Experience Medical Billing Medicare

How to Discover Better Insurance Coverage, Together

Healthcare IT Today

FEBRUARY 23, 2023

Many healthcare providers find themselves wondering whether a revenue cycle management (RCM) partner would benefit their organizations. Streamline the billing process The right RCM partner will help providers optimize revenue by creating faster, easier processes to identify insurance coverage.

RCM

RCM Medical Billing Patient Experience Medicare

Bonus Features – December 24 , 2023 – 74% of orgs automating RCM operations, per-physician revenue exceeding expenses at U.S. hospitals, plus 19 more stories

Healthcare IT Today

DECEMBER 24, 2023

Arizona-based VBCare Network selected Spatially Health for identifying barriers to health equity in Medicare and Medicaid beneficiaries. Chicago-area RML Specialty Hospital chose ScImage to support cloud-based PACS.

RCM

RCM eCare Healthcare IT Mental health

Bonus Features – November 5, 2023 – Only 24% of healthcare organizations have successfully disrupted ransomware attacks, 83% of healthcare leaders say AI is or will be an essential skill, plus 20 more

Healthcare IT Today

NOVEMBER 5, 2023

Although 90% of health systems face turnover rates of greater than 10% for roles in RCM and patient experience, only 25% of executives are looking at AI or workflow improvements to improve efficiency , an Experian Health survey found. RCM and price transparency company Rivet appointed Erick Sunarto as Vice President of Technology.

RCM

RCM Medicare EHR FHIR

Bonus Features – March 24, 2024 – Data infrastructure investments have 124% ROI, 85% of healthcare workers believe AI can improve the patient experience, plus 28 more stories

Healthcare IT Today

MARCH 24, 2024

Wellth launched Wellth Northstar to support Medicare Advantage plans aiming to motivate change in hard-to-reach members. Sales Humana tapped DUOS to help the manage the health of veterans in Louisiana with chronic conditions enrolled in Medicare Advantage plans. MultiPlan selected HealthCorum to support provider network optimization.

Patient Experience

Patient Experience RCM Healthcare IT Medicare

Avoiding Red Flags: Finding the Right Productivity Balance

Healthcare IT Today

NOVEMBER 22, 2022

The following is a guest article by John Wallace, PT, OCS, Senior Vice President of RCM at WebPT. The number of Medicare TPEs and commercial payer take-back audits alone is skyrocketing. They also look to flag “items and services that have high national error rates and are a financial risk to Medicare.” Tricare and Medicare).

Medicare

Medicare RCM Private practice Nursing

Bonus Features – July 23, 2023 – Number of people impacted by data breaches up 56% compared to last year, CMS keeps temporary telehealth expansion in 2024 Medicare fee schedule, and more

Healthcare IT Today

JULY 23, 2023

News and Studies The 2024 Medicare Physician Fee Schedule Proposed Rule from CMS would continue many of the public health emergency telehealth flexibilities, such as an expanded definition of telehealth practitioners, continued payments to rural health centers and FQHCs, and the expansion of originating sites.

Medicare

Medicare Telehealth Telemedicine RCM

Bonus Features – May 7, 2023 – Less than 1% of all medical claims include an ICD-10 Z code, 78% of consumers say virtual health is important when considering health plans, and more

Healthcare IT Today

MAY 7, 2023

News CMS has opened the Hardship Exception application period for eligible hospitals and critical access hospitals (CAHs) that participated in the Medicare Promoting Interoperability Program in 2022. EHR and RCM vendor for therapy and rehab practices Raintree released Raintree Payments.

RCM

RCM EHR Mental health BioTech

Bonus Features – November 12, 2023 – 93% of clinicians use RPM in cardiac care rehab, telehealth flexibilities remain in place until the end of 2024, plus 25 more stories

Healthcare IT Today

NOVEMBER 12, 2023

News The 2024 Medicare Physician Fee Schedule continues many telehealth flexibilities first adopted during the public health emergency, such as an expanded scope of originating sites an expanded definition of qualified practitioners. Sales Ohio-based Fisher-Titus chose RevSpring for RCM and payment processing.

Telehealth

Telehealth RCM Public Health EHR

Bonus Features – January 14, 2024 – Epic Research shows telehealth results in more follow-up visits that in-office care, Elevance Health to offer smartphones to qualified Medicaid beneficiaries, plus 21 more stories

Healthcare IT Today

JANUARY 14, 2024

The American Telehealth Association announced its policy priorities for 2024 ; they include making Medicare telehealth flexibilities permanent before the end of the year and removing the in-person requirement for the remote prescribing of controlled substances.

Telehealth

Telehealth EHR RCM Healthcare IT

Bonus Features – November 26, 2023 – 85% of healthcare orgs boosting IT spending in 2024, 70% of orgs actively considering generative AI, plus 18 more stories

Healthcare IT Today

NOVEMBER 26, 2023

This is due in large part to increased expenses (from 25$ for labor to 90% for maintenance) and revenue reductions from denials (more than 20% from commercial plans and nearly 60% from Medicare Advantage plans). RCM is by far the most popular potential use case, with 58% of all considering the use of generative AI there.

eHealth

eHealth RCM EHR FHIR

Canvas Medical Achieves ONC Certification, Raises $24MM to Power Clinicians and Developers Building and Scaling Digital Health Companies

Healthcare IT Today

JULY 19, 2022

Additionally, with this certification, Canvas customers are now eligible for value-based payment models in Medicare and Medicaid programs, as well as many commercial value-based programs. . Founded in 2015, Canvas is reimagining the EMR for the future of healthcare. For more information about Canvas Medical, visit canvasmedical.com. .

EMR

EMR Digital Health Primary Care RCM

Bonus Features – December 4, 2022 – 34% of Americans take anti-anxiety meds during the holidays, hospital margins at -2% but show signs of hope, and more

Healthcare IT Today

DECEMBER 4, 2022

RCM consultancy MDaudit announced three leadership team appointments : Raj Joshi as CISO, Jaenna Babajane as Vice President of Customer Experience, and Nisheet Goenka as VP of Engineering. Medicare ACO platform Vytalize Health named Frank Bordonaro as Senior VP of Value-Based Care and Network Development.

RCM

RCM Healthcare IT Leadership EHR

Bonus Features – November 19, 2023 – Critical access hospitals 16% less likely to participate in data exchange, two-thirds of orgs plan to increase AI spending by 25% in the next three years, plus 36 more stories

Healthcare IT Today

NOVEMBER 19, 2023

A Humana study found that Medicare Advantage members covered under value-based care arrangements completed preventive screenings at a 14.6% Azalea Health completed SOC 2 Type 2 Certification for its cloud-based EHR and RCM platform. Oly 51% are confident that hospital rooms are properly disinfected.

eCare

eCare Healthcare IT Interoperability RCM

Bonus Features – November 13, 2022 – HCA extends 30-year relationship with MEDITECH, cost of care replaces pandemic as top reason to defer care, and more

Healthcare IT Today

NOVEMBER 13, 2022

More than 80% of all claims denials are associated with Medicare , according to the latest annual benchmark report from RCM and auditing software maker MDaudit. healthcare system to keep them healthy. Outpatient claims have a 77% accuracy rate, and fixing this would increase revenue as much as $5.5

EHR

EHR RCM Healthcare IT Mental health

Bonus Features, HLTH Edition – October 11, 2023 – Announcements from Best Buy, General Catalyst, Google Cloud, Microsoft, Walgreens, and more

Healthcare IT Today

OCTOBER 11, 2023

Optum and Uber are partnering to make non-urgent medical transportation and healthy food delivery covered benefits for certain Medicare Advantage plans beginning in 2024. TrustCommerce integrated its patient payments platform with athenaIDX , athenahealth’s RCM product.

Life Science

Life Science EHR BioTech RCM

Weekly Roundup – July 29, 2023

Healthcare IT Today

JULY 29, 2023

Bonus Features for July 23, 2023: Number of people impacted by data breaches up 56% compared to last year, while CMS keeps temporary telehealth expansion in 2024 Medicare fee schedule. based EMR, RCM, and practice management assets to N. Concierge care platform Gradia Health secured $4.2 million in seed funding. CloudMD sold its U.S.-based

Healthcare IT

Healthcare IT Leadership eHealth RCM

Bonus Features – August 6, 2023 – 83% of hospitals are collecting SDoH data, 46% of hospitals planning to use large language models in the call center, and more

Healthcare IT Today

AUGUST 6, 2023

Chicago-based RUSH University System for Health chose Cadence for remote monitoring and virtual care for Medicare and Medicaid patients with chronic conditions. EHR and RCM vendor ModMed appointed Denise Ceule as Chief Legal Officer. In addition, Texas-based Midland Community Healthcare Services is transitioning to eClinicalWorks.

EHR

EHR Interoperability RCM HIE

The Role of RCM in Health Equity

Healthcare IT Today

NOVEMBER 25, 2022

Involving revenue cycle management (RCM) is necessary for any comprehensive SDoH/health equity strategy. Reimbursement is also closely linked to quality because of the use of outcome measures by the Centers for Medicare and Medicaid Services (CMS) to determine a hospital’s overall quality, including: Mortality. Safety of care.

RCM

RCM Medicare Interoperability Patient Experience

Bonus Features – April 30, 2023 – 68% of providers say improving patient collections is a high priority, hospital expenses have increased 2x the Medicare IPPS reimbursement rate since 2019, and more

Healthcare IT Today

APRIL 30, 2023

from 2019 to 2022 – or more than double the rate of increase for Medicare IPPS reimbursement (7.5%). RCM vendor medaptus is collaborating with Fresenius Kabi to offer hospitals financial reimbursement software for infusion services. RCM vendor Savista hired Warren Jacobson as Vice President of Client Revenue Cycle.

Medicare

Medicare RCM Healthcare Cybersecurity Healthcare IT

Telehealth Startup OpenLoop Raises $15 Million to Streamline Virtual Care Delivery

Healthcare IT Today

MARCH 27, 2023

New Payer Coverage and Revenue Cycle Management With 250 million patient lives covered under 600+ of the nation’s top payers, including Medicare, Medicaid and every major private insurer, OpenLoop is also announcing today a new Payer Coverage & RCM service.

Telehealth

Telehealth RCM HIPAA Digital Health

Weekender 4/26/19

HIStalk Weekender

APRIL 26, 2019

Bain Capital hires financial advisors to help it assess the potential sale of RCM vendor Waystar. HHS announces CMS Primary Cares, two value-based care payment models launching in 2020 that it says will cover at least 25% of Medicare beneficiaries and providers. Athenahealth lays off 200 employees.

RCM

RCM Primary Care EHR Nursing

Weekly Roundup – July 23, 2022

Healthcare IT Today

JULY 23, 2022

The unofficial theme of this year’s HFMA conference was how hospitals are dealing with staffing challenges in RCM and collections. One Hospital’s Approach to Better Revenue Cycle Efficiency.

Primary Care

Primary Care RCM EMR Healthcare IT

Bonus Features – January 8, 2023 – Omnibus bill extends telehealth expansion through end of 2024, 60% of solution providers pouring all event marketing money into in-person events, and more

Healthcare IT Today

JANUARY 8, 2023

The biggest news for healthcare IT was the extension of telehealth expansion under Medicare through the end of 2024. The first quarterly Healthcare IT Market Report from Pivot Point Consulting hinted at a continued need for providers to develop long-term strategies around virtual care, customer relationship management, and RCM optimization.

Telehealth

Telehealth Healthcare IT Primary Care Leadership

Bonus Features – October 8, 2023 – 67% of Women are Having Issues with Getting a Clear Diagnosis – of which 25% are Still Waiting for Diagnosis or Gave up Entirely, Health Gorilla has 17 Healthcare Organizations Commit to Joining their QHIN, and More!

Healthcare IT Today

OCTOBER 8, 2023

Claims on the community care program, Connect for Life (CFL), from Wider Circle preventing 8 ED visits per 1,000 members, saving $103 Per Engaged Member Per Month net savings for Medicare Advantage members, and more have been validated in a recent review from Milliman.

eCare

eCare Primary Care RCM Patient Experience

HIStalk Interviews Gabriel Orthous, CIO, Central Georgia Health Network

HIStalk Interviews

JUNE 12, 2019

Usually those are part of a system of trying to identify CPT codes or ICD codes in order to get paid through a billing RCM model. But when you get into Medicare, ACO, or frailty, for example … frail patients who come in may be prescribed seven medications in seven points of care. That’s just one component.

EMR

EMR RCM HIE Interoperability

Connected Health Pulse

Turning Increased Ambulatory Volumes into Financial Strength: 4 Moves for RCM

How to Discover Better Insurance Coverage, Together

Trending Sources

Bonus Features – December 24 , 2023 – 74% of orgs automating RCM operations, per-physician revenue exceeding expenses at U.S. hospitals, plus 19 more stories

Bonus Features – November 5, 2023 – Only 24% of healthcare organizations have successfully disrupted ransomware attacks, 83% of healthcare leaders say AI is or will be an essential skill, plus 20 more

Bonus Features – March 24, 2024 – Data infrastructure investments have 124% ROI, 85% of healthcare workers believe AI can improve the patient experience, plus 28 more stories

Avoiding Red Flags: Finding the Right Productivity Balance

Bonus Features – July 23, 2023 – Number of people impacted by data breaches up 56% compared to last year, CMS keeps temporary telehealth expansion in 2024 Medicare fee schedule, and more

Bonus Features – May 7, 2023 – Less than 1% of all medical claims include an ICD-10 Z code, 78% of consumers say virtual health is important when considering health plans, and more

Bonus Features – November 12, 2023 – 93% of clinicians use RPM in cardiac care rehab, telehealth flexibilities remain in place until the end of 2024, plus 25 more stories

Bonus Features – January 14, 2024 – Epic Research shows telehealth results in more follow-up visits that in-office care, Elevance Health to offer smartphones to qualified Medicaid beneficiaries, plus 21 more stories

Bonus Features – November 26, 2023 – 85% of healthcare orgs boosting IT spending in 2024, 70% of orgs actively considering generative AI, plus 18 more stories

Canvas Medical Achieves ONC Certification, Raises $24MM to Power Clinicians and Developers Building and Scaling Digital Health Companies

Bonus Features – December 4, 2022 – 34% of Americans take anti-anxiety meds during the holidays, hospital margins at -2% but show signs of hope, and more

Bonus Features – November 19, 2023 – Critical access hospitals 16% less likely to participate in data exchange, two-thirds of orgs plan to increase AI spending by 25% in the next three years, plus 36 more stories

Bonus Features – November 13, 2022 – HCA extends 30-year relationship with MEDITECH, cost of care replaces pandemic as top reason to defer care, and more

Bonus Features, HLTH Edition – October 11, 2023 – Announcements from Best Buy, General Catalyst, Google Cloud, Microsoft, Walgreens, and more

Weekly Roundup – July 29, 2023

Bonus Features – August 6, 2023 – 83% of hospitals are collecting SDoH data, 46% of hospitals planning to use large language models in the call center, and more

The Role of RCM in Health Equity

Bonus Features – April 30, 2023 – 68% of providers say improving patient collections is a high priority, hospital expenses have increased 2x the Medicare IPPS reimbursement rate since 2019, and more

Telehealth Startup OpenLoop Raises $15 Million to Streamline Virtual Care Delivery

Weekender 4/26/19

Weekly Roundup – July 23, 2022

Bonus Features – January 8, 2023 – Omnibus bill extends telehealth expansion through end of 2024, 60% of solution providers pouring all event marketing money into in-person events, and more

Bonus Features – October 8, 2023 – 67% of Women are Having Issues with Getting a Clear Diagnosis – of which 25% are Still Waiting for Diagnosis or Gave up Entirely, Health Gorilla has 17 Healthcare Organizations Commit to Joining their QHIN, and More!

HIStalk Interviews Gabriel Orthous, CIO, Central Georgia Health Network

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