Client News Coverage

Denials are rising for physician practices, with 73% of respondents to Experian’s 2024 State of Claims survey reporting that claims are being denied more frequently, up 10% over 2022. It’s bad news for practices that are already struggling to get paid, with nearly 50% of respondents reporting denial rates of 10% and higher.

Revenue leakage may be the most apparent outcome of denied claims, but it is far from the only serious impact. Reworking denied claims consumes time and resources that few practices can spare. Also, frequent denials can lead to a crisis of confidence in payer relationships and technological support. According to Experian, providers’ confidence in payer reimbursements is sinking, due to patient concerns and stringent payer policies. Furthermore, only 54% of respondents were confident in their ability to manage revenue cycle demands with technology in 2024, compared to 77% in 2022.

Hospitals are paid for the services they provide using diagnosis related group (DRG)-based retrospective payments, making the quality of reported diagnosis and procedure codes crucial. As such, it is essential to promptly address inpatient coding errors to prevent future financial losses and maintain hospital margins. Through quality improvement, hospitals can improve inpatient coding and DRG validation to secure proper reimbursement for inpatient hospital stays. Quality improvement is defined by the Centers for Medicare & Medicaid Services as “the framework used to improve care systematically.”

In this article, we will use quality improvement tools to look at the effect medical coding has on the quality of data submitted for inpatient care reimbursement.

The new federal Health Technology Ecosystem that President Donald Trump announced from the White House on Wednesday is designed to kill the need for faxed patient records and open up app-based innovation and data sharing between patients and the wider healthcare system.

According to the U.S. Centers for Medicare & Medicaid Services, which is spearheading the effort, the new interoperability framework will enable the sharing of patient medical records through a new initiative called the CMS Aligned Network.

Healthcare organizations are engulfed in an intensifying storm of audits and denials exacerbated by heightened regulatory and payer scrutiny. Individually, any of these trends can endanger a hospital’s or health system’s financial stability. Combined, they represent a crisis calling for immediate action.

Healthcare finance leaders who wish to successfully guide their organizations across this increasingly complex and challenging landscape must transform their revenue cycle management (RCM) strategies. Central to this transformation is proactive risk monitoring and the implementation of AI-driven compliance strategies.

In healthcare revenue cycle management (RCM), we’ve long relied on automation systems that process rules-based workflows with limited or no need for complex logic and nuanced judgement. Robotic Process Automation (RPA) has been highly effective at automating repetitive, high-volume tasks such as claim status checks and data entry.

However, its limitations are increasingly apparent. Today’s revenue cycle challenges demand more than just speed and efficiency; they require adaptability, context, and intelligent decision-making.

The HIMSS Electronic Health Record Association in the US has gone to respond to a new request pertaining to the information from the US Department of Health and Human Services by seeing it as a very crucial opportunity in order to examine regulations that don’t reflect the present technology or market realities and also go ahead and make corrections to the misaligned approaches when it comes to rulemaking.

It is well to be noted that EHRA submitted the comments pertaining to its reform as well as regulatory priorities to the HHS. This was in response to its request for information (RFI) ensuring lawful regulation and unleashing innovation to make America healthy again request for information. Apparently, the EHR has asked the HHS to modernizing the regulatory approach to RFI.

The HIMSS Electronic Health Record Association has responded to a new request for information from the U.S. Department of Health and Human Services, seeing it as a critical opportunity to examine regulations that don’t reflect current technology or market realities, and to correct “misaligned” approaches to rulemaking.

The EHRA submitted comments about its reform and deregulatory priorities to the HHS in response to its RFI, “Ensuring Lawful Regulation and Unleashing Innovation To Make America Healthy Again Request for Information.”

The HIMSS Electronic Health Record Association has responded to a new request for information from the U.S. Department of Health and Human Services, seeing it as a critical opportunity to examine regulations that don't reflect current technology or market realities, and to correct "misaligned" approaches to rulemaking.

The EHRA submitted comments about its reform and deregulatory priorities to the HHS in response to its RFI, "Ensuring Lawful Regulation and Unleashing Innovation To Make America Healthy Again Request for Information."

There are a lot of new and improved tools and technologies in healthcare — a wonderful display of people working to make the world of healthcare better for patients and your organization’s staff. But sometimes, no matter how helpful and useful a piece of technology can be for your organization, it might not be compatible with your existing technologies. Today, we are going to narrow our focus on integrating RCM software with existing electronic health record (EHR) systems.

We reached out to our brilliant Healthcare IT Today Community to ask — what are the main challenges in integrating RCM software with existing EHR systems, and how can these be addressed? The following are their answers.

AI and automation are revolutionizing healthcare revenue cycle management (RCM), reducing inefficiencies, optimizing financial workflows, and enhancing the patient experience. Yet many health systems struggle to navigate the complexities of adoption due to limited financial and human resources or uncertainty over the potential value that these technologies can deliver.

It is important to understand that automation is a continuum, progressing from rules-based workflows to AI-driven predictive analytics, chatbots, and generative AI solutions. AI is already transforming key aspects of patient access and financial clearance, including scheduling, insurance benefit verification, and prior authorizations, as well as clinical documentation, coding, and management of denied claims, reducing administrative burdens and improving cash flow and revenue.

Real-time insights are a topic we and many others have discussed before. Being able to see immediately what works and what does not work is an incredible tool for organizations; especially when it comes to areas like patient experience and revenue cycle management. But how do we get these real-time insights? New tools and technologies are constantly being developed and improved in the world of healthcare. So, how do you know which ones you need to get your desired results?

In search of those answers, we reached out to our incredible Healthcare IT Today Community to ask — what tools or technologies are most effective in providing real-time insights into financial performance and key RCM metrics? The following is what they had to share.

Driven by increased data consumption, the rapid uptick in cloud computing and hybrid cloud models, and emerging trends toward decentralization and edge computing, the U.S. data center market is projected to exceed $613 billion over the next decade. The heightened demand for AI-related data centers also comes into play, driving $31.5 billion in annualized spending on new data center construction and pushing the development pipeline to nearly 50 million square feet.

Behind the surge in data center popularity is a desire for greater cybersecurity than many organizations can provide in-house, putting pressure on center operators to provide secure, uninterrupted large-scale operations. It’s a particularly thorny challenge as bad actors increasingly set their sights on data centers and the immense volume of valuable information they hold.

Healthcare industry stakeholders made their case to leaders in President Donald Trump's health department last week about the need to improve the nation's health information technology infrastructure.

The request for information garnered just over 1,300 comments from trade groups, provider and hospital associations, individual companies, payers, patients and providers. The comment letters spanned the gamut of traditional health IT issues, such as issues with the Trusted Exchange Framework and Common Agreement (TEFCA) and weak enforcement of information blocking rules.

Providers, payers and health tech vendors have laid out a long to-do list for federal regulators on how the administration can optimize technology in healthcare.

The EHR Association shared its feedback on two NPRMs recently: to ASTP/ONC regarding the 2025 Standards Version Advancement Process (SVAP), and to CMS regarding the FY 2026 IPPS proposed rule (CMS–1833–P).

Health IT Answers»