By Ryne Natzke -The standard billing process waits until after care ends, a claim is processed, and a balance is finalized to have any real conversation about cost. By then, the patient has moved on and has no context for the number in front of them. The result is a confused patient and a structurally slower path to payment, built on surprise balances, inbound billing calls, and slower collections.
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By Frank Forte – A CFO in a large Midwest health system had what looked like an easy call to make. Consolidate the organization’s complex claims into a single generalist revenue cycle management (RCM) platform and save roughly $400,000. The added benefit was fewer vendors to manage.
By Ricky Bell – For the past decade, I have sat in boardrooms and clinical offices watching healthcare organizations pour millions into Electronic Health Record (EHR) optimization, artificial intelligence, and interoperability. The goal is always the same, and that is operational excellence. Yet, when we look at the revenue cycle, that investment often hits a wall.
By David Main DC – Of everything artificial intelligence was going to fix in healthcare, billing looked like the softest target. It is rule-bound, high-volume, repetitive. The code sets are published, the edits are published, the payer policies at least nominally so. If you had asked me three years ago where AI would land first and hardest, I would have said the revenue cycle without hesitating.
Reported payers and health insurance industry news from EHVA.ai, UnitedHealthcare, Independence Blue Cross, Anthem Blue Cross and Blue Shield, CVS Health, CareFirst BlueCross BlueShield, Humana, UnitedHealth Group, Cigna Healthcare, AHIP, and more.
By Brian Robertson -To improve revenue cycle management (RCM) through AI, organizations first have to change how they see the revenue cycle itself. RCM is no longer operational support. It is a core driver of enterprise strategy, corner office and all.
By Anne Neal – For years, the industry has measured payment integrity success largely through recoveries, savings, and avoided overpayments. However, achieving those metrics often comes at the cost of significant abrasion that manifests as claims rework, provider tension, cash flow unpredictability, and poor member experience.
By Syed Sibt-e-Hassan – Most practices judge a good month by the balance in the bank. It is the slowest and least useful way to understand revenue. By the time a shortfall shows up in the account, its causes are weeks old and often past the point of recovery.
By Rafiq Ahmed – For decades, one of the most consequential numbers in healthcare was effectively invisible to the providers delivering care: what a payer actually reimburses a hospital for a given service. Health systems negotiated contracts based on internal assumptions, historical precedent, and incomplete intelligence about what the market was actually paying.