Client News Coverage

In a letter to the Centers for Medicare and Medicaid Services, the HIMSS Electronic Health Record Association said a proposed reporting timeline in the 2026 Outpatient Prospective Payment System/Ambulatory Surgical Center Proposed Rule is too aggressive.

Health IT vendors and hospitals need more time to develop and implement the necessary software and staff training, said EHRA leaders.

Healthcare IT News»

Efficient revenue cycle management (RCM) is a persistent challenge for healthcare organizations. It encompasses patient registration, coding, billing, claims submission, and collections. These processes are complex, labor-intensive, and prone to error. In fact, administrative costs account for over 40% of U.S. hospital expenses, amounting to roughly US$ 160 billion each year on RCM activities. Amid this scale of spending, even a few percentage points of errors or denials translate to billions of dollars in lost revenue.

For example, recent government figures show that Medicare Fee-for-Service had an estimated 7.66% improper payment rate in FY2024, reflecting widespread billing and coding errors. Moreover, CMS notes that the ‘vast majority’ of these improper payments occur because claims lack sufficient documentation. This finding suggests that many payment errors are avoidable with better data capture and review.

There’s a quiet truth running beneath the flood of headlines about ransomware in healthcare: the breach isn’t always the worst part.

I’ve worked with healthcare and dental practices for more than two decades, from busy urban outpatient clinics to multi-site dental groups in rural towns. The story that rarely makes the news is what happens after a cyberattack: the calls from providers whose practices have come to a complete standstill, staff resorting to manually pulling paper charts, and owners left to calculate whether they’ll be able to reopen. I’ve heard the fear and anxiety in the wake of a cybersecurity incident, being told on more than one occasion, “I wasn’t scared when it happened. I was scared when I realized how long we’d ignored it.”

Health IT Answers»

Tell me about yourself and the company.

We are primarily a revenue cycle management company. We work with pretty large enterprises, such as Mayo Clinic, Cleveland Clinic, and Baylor Scott & White Health. We offer services on the front end, which is usually scheduling, patient access-related functions, mid-cycle coding, and in the back end, AR and denials.  We are about 15,000 people. We are what I would call a tech-first services company.

My career over the past 20-odd years has been primarily in technology. I’ve been focused on building data-intensive apps. In the last two or three years, I’ve been pretty intrigued with AI and its applications.

What are the biggest pain points in RCM that technology may help solve?

 HISTalk»

MDaudit, an award-winning cloud-based continuous risk monitoring platform for RCM that enables the nation’s premier healthcare organizations to minimize billing risks and maximize revenues, has finalized its acquisition of Streamline Health Solutions, Inc., a leading provider of solutions that enable healthcare providers to improve financial performance. The addition of Streamline’s pre-bill integrity solutions to its robust billing compliance and revenue integrity platform positions MDaudit to bridge crucial RCM gaps, thereby mitigating billing compliance risks and strengthening and streamlining the revenue cycle.

First announced in May, the acquisition brings together two healthcare RCM powerhouses supporting healthcare organizations with a combined net patient revenue of more than $300 billion. The companies’ shared belief in centering customer satisfaction while leveraging the latest technologies converges into a powerful platform capable of meeting head-on the revenue cycle realities confronting organizations in today’s complex healthcare environment.

Rising operating costs, shrinking operating margins, and a complex payer landscape characterized by heightened prior authorization requirements and a push to embed advanced technology more deeply into the review process have thrown provider finances into turmoil. Exacerbating it all is a chronic and worsening shortage of skilled revenue cycle management (RCM) professionals, including patient access.

Internally, the inefficiencies created by outdated, time-consuming, and cost-intensive patient access operations hinder timely access to care, contributing to revenue leakage and further weakening the organization’s bottom line. Moreover, many provider organizations lack the insights to identify and remediate systemic issues that undermine patient access operations.

A computer-assisted coding system (CACS) is software that analyzes healthcare documents and automatically produces appropriate medical codes, like the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), ICD-10-CMand the American Medical Association's Current Procedural Terminology (CPT) for specific phrases and terms within the document. Healthcare organizations need these codes to maintain accurate patient medical records and to ensure accurate, error-free billing and reimbursements.

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.