Billing and Collections

Health systems need vendor goals, communication and improvement plans, say revenue cycle experts.

Physician-trained AI can recover millions in lost revenue by reducing denials, says Dr. Michael Gao, CEO and cofounder of SmarterDx.

<p>For Medicare Advantage audits, there must be evidence in the medical documentation to support the billing codes, says David Lareau, CEO of Medicomp Systems.</p>

<p>The Medicare Advantage Risk Adjustment Validation final rule has ramped up compliance pressure against overcoding, says Dr. Calum Yacoubian, director of healthcare strategy at IQVIA.</p> <p> </p>

Fifty-two percent of insured Americans say paying for medical bills creates stress that is affecting their health.

During AHIP 2023, Prx Health tackles the issue of billing codes being needed for reimbursement and to prevent inappropriate use of the ER.

<p class="MsoNoSpacing"><span style="font-size:11pt"><span style="font-family:"Calibri",sans-serif">The challenge is the administrative burden on providers because there are no agreed-upon standards and measures, say Inovalon SVPs Kristopher Volrath and Karly Rowe.</span></span></p>

Physician-owned practices reported higher levels of compensation than hospital-owned practices.

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Workforce shortages and staffing churn spurred many to look into outsourcing revenue cycle management and patient collections.