News

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.

Healthcare mergers and acquisitions are in no short supply as providers, health tech companies, retailers and other industry players look to expand their businesses and gain a competitive edge. Here’s a roundup of new deals that were revealed, closed, rumored or called off during the month of July.

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.

Welcome to the weekly edition of Healthcare IT Today Bonus Features. This article will be a weekly roundup of interesting stories, product announcements, new hires, partnerships, research studies, awards, sales, and more. Because there’s so much happening out there in healthcare IT we aren’t able to cover in our full articles, we still want to make sure you’re informed of all the latest news, announcements, and stories happening to help you better do your job.

In a new action plan, the White House aims to boost the country’s AI innovation through deregulation, infrastructure expansion and new incentives. Overall, the move is welcomed by healthcare AI leaders — but they did notice some omissions, including AI safety, patient consent and the role of key healthcare regulators.

MedCity News»

In support of HHS Secretary Robert F. Kennedy Jr’s goal of streamlining prior authorization, HHS’ chief health IT office (ASTP/ONC) on Thursday (July 31) finalized a contentious regulation requiring electronic health records and other health information technology for which companies are seeking federal certification to incorporate prior authorization application programming interfaces (APIs) that facilitate information sharing between providers and payers.

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 IT News»

A Watershed Moment for Health IT Regulation

The U.S. Department of Health and Human Services (DHHS) recently concluded its Request for Information (RFI) to identify outdated or misaligned regulations “stifling innovation” in healthcare technology. This effort, framed by Executive Orders 14219 and 14192, represents the current administration’s deregulatory push and the largest in DHHS history.

With responses from major Health IT stakeholders — including the Electronic Health Record Association (EHRA), National Committee for Quality Assurance (NCQA), and AdvaMed (as well as my own submission) — the debate over clinical decision support (CDS) tools, FDA-ONC jurisdictional conflicts, and public health infrastructure has reached a critical juncture.

Medium»

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.