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Why is Revenue Cycle Management Important in Healthcare?
Revenue Cycle Management (RCM) is vital for a thriving healthcare organization. Balancing exceptional care with financial steadiness can be...
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7 min read
Revenue Cycle Management (RCM) is vital for a thriving healthcare organization. Balancing exceptional care with financial steadiness can be...
Read More7 min read
In today’s healthcare landscape, where financial sustainability is top of mind, delayed claims processing can be a significant roadblock to cash flow and overall revenue cycle efficiency. Hospitals and health systems face heightened risk when claims are...
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Grasping the details of the claims lifecycle in healthcare is crucial for getting timely reimbursements and maintaining financial well-being. As healthcare organizations strive for an efficient and accurate claims management process, it’s crucial to...
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In today’s complex healthcare landscape, accurate reimbursement is crucial for maintaining financial health and operational efficiency. Revenue cycle management teams face the challenge of ensuring payment accuracy from multiple payers, each with its own...
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Medicare offers important financial protection by providing health insurance coverage to 67 million people in the U.S., including adults age 65 or older and younger adults with long-term disabilities.
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Medicare offers important financial protection by providing health insurance coverage to 67 million people in the U.S., including adults age 65 or older and younger adults with long-term disabilities.
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Claims management accuracy and efficiency are crucial for hospital billing, accounting and finance professionals. However, common missteps can cause expensive delays, denials and reimbursement deficiencies. Below, we explore the top five mistakes in...
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In the complicated world of healthcare billing, capturing charges accurately is crucial for a hospital’s revenue cycle. Charge capture errors can cause substantial revenue losses, payment delays and even compliance problems.
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The determination to overcome recent challenges like reduced patient visits and tighter margins is now paying off for providers with a promising transition from survival mode to revenue growth, as highlighted in Kaufman Hall’s March 2024 National...
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By Jonathan Wiik, Vice President, Health Insights, FinThrive
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The relationship between providers and payers has always been challenging, and the current landscape is marked by heightened tension. With rising denial rates and increasing administrative burdens surrounding payer rule changes, it's clear both sides...
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In today’s healthcare environment, maintaining secure and continuous claims management is more crucial than ever. Recent cyberattacks highlight the vulnerabilities organizations face without robust backup systems. When claims systems fail, revenue...
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The healthcare industry is currently grappling with a major challenge: ensuring staff satisfaction. Several key issues contribute to this problem, including overwhelming workloads, frustration with multiple systems and limited opportunities for career...
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Picture this: you’re juggling multiple RCM vendors, each claiming to be the best at their part of the puzzle. But instead of fitting together seamlessly, they create a complex web of processes that stretch your resources thin. So, how do you know when...
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In the world of healthcare revenue cycle management, you often hear terms like clean claim rate, claim denial rate and claim rejection rate. While each of these metrics plays a crucial role in the financial health of a healthcare organization, focusing...
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In today’s healthcare landscape, patient satisfaction is paramount. With the rising costs of healthcare and the increasing financial burden on patients, transparency in billing has never been more critical. Patients expect clear, accurate and timely...
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Preventing healthcare denials is both essential and challenging for health systems and hospitals.
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In the healthcare industry, accurate insurance verification is crucial for patient care and overall revenue. Despite its importance, many healthcare providers are still prone to common errors during the verification process.
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The 2024 HFMA Annual Conference returned to Las Vegas this year…and man was it HOT! Not only did we have triple-digit temps all week, the conference also had some exciting content as well. The event kicked off with the Rat Pack of all things, Den-O, old...
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Navigating the complex landscape of healthcare can be challenging for patients, especially when it comes to understanding and managing insurance coverage. One of the critical ways providers can improve the patient experience is through searching for...
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In an era marked by rapid technological advancements and unforeseen challenges, healthcare institutions are increasingly vulnerable to interruptions. These interruptions, often in the form of cybersecurity threats, have the potential to halt operations...
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Across the industry, provider organizations are experiencing pressure due to staffing shortages, payer challenges, shrinking margins and constantly evolving regulations. In response, vendors are developing comprehensive platforms that house a full suite...
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Last year, over half of healthcare providers reported an increase in denied claims within their organizations. Common reasons cited included registration errors, inadequate documentation and inaccurate or missing patient information.
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In the complex world of healthcare, managing revenue efficiently is critical. With multiple payer types and diverse patient categories, the reimbursement process can be daunting, prone to errors, and highly labor-intensive. The evolution of technology...
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The escalation of data breaches and cyberattacks targeting hospitals and healthcare facilities is a growing concern. According to the HHS Office for Civil Rights (OCR), there has been a notable increase in cyber incidents within the healthcare sector. ...
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Last month, we shared insights with Dr. Neil and Dr. Jubelt, highlighting the importance of a patient-centric approach and collaboration to advance a shift towards value-based care.
In this edition of our Healthcare Voices series, we met with two...
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It has been a little more than two years since the No Surprises Act was implemented, with provisions designed to address unexpected gaps in insurance coverage that result in “surprise medical bills” when patients unknowingly obtain medical services from...
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The healthcare industry is a dynamic landscape, constantly evolving to meet the changing needs of both providers and patients. Providers are feeling the financial squeeze due to rising labor costs and deteriorating payer relationships, all while trying...
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The recent requirements introduced by the Centers for Medicare & Medicaid Services (CMS) on November 22, 2023, outlined significant changes to the Price Transparency initiative, specifically focusing on the machine-readable file (MRF).
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The healthcare industry is constantly evolving, but one constant remains – providers continue to face a variety of challenges, including reduced payments, increased denials, higher labor costs and decreased patient volumes.
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Navigating the healthcare system as a provider can often feel like an elaborate game of approvals, especially when it comes to the prior authorization process. Despite advances in technology, this critical element of maintaining financial health elicits...
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The pressure to optimize revenue streams while maintaining financial stability is a constant challenge in the ever-evolving healthcare arena. Amidst this complexity, the accuracy of contract negotiations and payment reconciliation emerges as a critical...
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According to a recent survey from the Healthcare Financial Management Association (HFMA) and Eliciting Insights, hospitals and health systems find themselves navigating financial hurdles amidst lower reimbursement rates and increased denials. As a...
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In the ever-evolving landscape of healthcare, finding the right insurance discovery partner is crucial for maximizing revenue recovery and ensuring the financial health of your organization. The process can be daunting, but understanding what to look for...
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Recently, we had the opportunity to interview two impactful healthcare leaders, Dr. Lindsay Jubelt and Dr. Gianni Neil. Through our discussion, both leaders offer insightful perspectives about the intersection of technology, data and value-based care....
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In the world of healthcare, everything comes down to making sure patients get the best care possible. But to do that, there's a lot going on behind the scenes, especially when it comes to healthcare revenue cycle management and making sure providers are...
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By Jeff Becker, Vice President, Portfolio Marketing, FinThrive
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The recent proposal introduced by the Centers for Medicare & Medicaid Services (CMS) on July 31, 2023, outlined significant changes to the Price Transparency initiative, specifically focusing on the machine-readable file (MRF).
5 min read
In the dynamic realm of healthcare, adaptability is key, and FinThrive Analyze delivers flexible innovation. Today, we're thrilled to introduce two groundbreaking modules, Data Hub and Insights Hub, as part of our FinThrive Analyze analytics solution....
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Healthcare organizations have a lot on their plate, and how well they manage revenue is crucial to their financial well-being. Revenue Cycle Management (RCM) acts as a vital link in the intricate world of patient care, documentation, payment, regulations...
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As the year 2024 unfolds, the urgency of addressing the inefficient and costly authorization process for healthcare financial leaders persists. With its intricate web of time and...
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By Jeff Becker, Vice President, Portfolio Marketing, FinThrive
The world's largest healthcare conference is on the horizon, geared up to welcome nearly 40,000 participants. From vendor booths on the exhibit hall floors to educational sessions, networking...
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The prior authorization process stands as one of the most intricate and resource-intensive tasks faced by healthcare providers today. It has been a pervasive issue in the industry for years, and there has not been much collaboration or headway made to...
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Healthcare organizations are feeling the sting of unpaid care, which surged by 33% from Q1 2023 to July 2023. And while it may not be possible to eliminate it, there are initiatives you can put in place today to lessen its impact.
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The healthcare sector is confronting an unprecedented staffing crisis, which has only intensified since the pandemic, and is putting strain on revenue cycle management (RCM) teams. According to a recent HFMA survey, every respondent reported open revenue...
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In 2023, more than 50% of healthcare providers said the number of denied claims rose for their organizations, most often due to errors in registration, lack of documentation and missing or incorrect patient information.
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By Jonathan G. Wiik, Vice President, Healthcare Industry Insights, FinThrive
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Let’s be honest – navigating healthcare is a difficult and stressful experience. At a time when almost everything in our lives has gone digital – booking flights, making dinner reservations, getting a ride, ordering groceries, and more. Unfortunately,...
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With Medicare reimbursements from the Centers for Medicaid and Medicare Services (CMS) accounting for approximately 32% of hospital revenue, it’s essential for healthcare leaders to comprehend the complexity of these payments.
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As the healthcare industry embraces digital transformation, automation has emerged as a promising approach to challenges that threaten the financial stability of organizations. In fact, 50% of providers are projected to have invested in automation by the...
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Since 2020, the healthcare industry has been hit hard by staffing shortages, with an estimated 20% in workforce reduction. Labor shortages are affecting all areas of healthcare organizations, not just clinical.
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In today’s challenging healthcare landscape, effective revenue cycle management (RCM) has become paramount for healthcare providers despite years of investment in point solutions and the EHR system. With the complexity of RCM, process improvement across...
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Navigating reimbursements for the Medicare program has been a long-standing challenge for many providers. With the government reimbursement landscape constantly shifting due to policy changes, complex regulations and nuances related to patient coverage,...
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Every year, Great Place to Work’s National Certification Nation Day shines a spotlight on organizations that have gone above and beyond to create a positive and fulfilling workplace for their colleagues. On this day we recognize and celebrate the...
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By Jonathan G. Wiik, Vice President, Health Insights, FinThrive
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Adoption of chargemaster data in health economics and outcomes research (HEOR) is typically less common than more prevalent real-world datasets such as claims or EHR data, primarily due to chargemaster being a hospital specific dataset. However,...
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By Jeff Becker, Vice President, Portfolio Solutions, FinThrive
Earlier this year, FinThrive partnered with AlphaSights to conduct a comprehensive body of research among RCM leaders. This initiative was designed to gather the latest trends...
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By Jonathan G. Wiik, Vice President, Health Insights, FinThrive
The 2023 HFMA Region 8 Mid-America Summer Institute (MASI) was a great educational conference. There were about 400 folks in attendance, ranging from large health systems and critical access...
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Claim denials can be a frustrating and costly experience for both healthcare providers and patients—in 2022, the costs of claim denials rose 67%. To prevent claim denials and ensure a smooth, efficient revenue cycle management process, it’s important to...
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In the healthcare industry, compliance is essential to protect providers from potential and significant legal or financial risks. However, compliance can also serve as a cornerstone for building revenue, cutting costs and delivering exceptional patient...
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Several recent trends in the healthcare market have worsened the urgent issue of hospital denial management. Hospitals are grappling with the collection of their rightful payments, and each of these new developments poses an added threat. Let's explore...
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Medical practices, health systems and hospitals’ primary goals are to provide life-saving care and keep patients healthy. Like any other business, however, these healthcare organizations must also focus on their own financial health to stay afloat....
11 min read
Hospitals are starting to see some daylight as we approach the second half of 2023. Per normalized data from a recent June Kaufman Hall report, signs of recovery continue with three consecutive break-even months. Volumes have continued to stabilize, with...
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By Greg Lanier, Chief Growth Officer, FinThrive
2023 HFMA Annual did not disappoint! I was honored to be at such an electric event amongst many health system, hospital, provider, and business partner leaders across the country. The Gaylord Opryland...
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A recent report by The Kaiser Family Foundation showed that claim denials are on the rise, with some plans reaching up to 80% in denials. Based on these findings, combined with a shifting payer mix, it’s estimated that 52% of patients will have...
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On May 11, 2023, the federal Public Health Emergency (PHE) will expire, and along with the Consolidated Omnibus Act, will impact coverage for millions of Americans on Medicaid. This is arguably the biggest thing to happen to Medicaid since the passing of...
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Hospitals grapple with many complex issues that impact their financial health—staffing shortages, policy changes, retail competitors. However, one of the top financial impacts is fairly simple: missed insurance reimbursement due to eligibility denials.
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By Greg Lanier, Chief Growth Officer, FinThrive
HIMSS ’23 saw more than 35,000 attendees, as healthcare executives from around the world gathered to tackle the industry’s toughest challenges. Several themes emerged from the conference surrounding...
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By Greg Lanier, Chief Growth Officer, FinThrive
Last week, key customer executives from FinThrive gathered for two days in Sarasota, Florida. The discussion was electric, innovative, engaging, and transformative. Seema Verma, former CMS Administrator,...
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By Jonathan G. Wiik, Vice President, Health Insights, FinThrive
Welcome to the April 2023 edition of Revenue Management Insights. This month, we'll be discussing several important trends that are impacting the healthcare industry, including hospital...
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Medical debt is more than a financial problem. Research is beginning to show that, for millions of Americans, medical debt leads to poor health outcomes.
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More than 1.5 million people—including nearly 750,000 children—lost their Medicaid coverage in 2018, according to a study conducted that year. Researchers determined it was most likely due not to ineligibility but to paperwork barriers.
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By Jonathan G. Wiik, Vice President, Health Insights, FinThrive
Welcome to the March edition of Healthcare Revenue Management Insights. Just as we’re starting to see flowers poking up through the snow (those of us in Colorado, at least), hospitals have...
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The Father of Population Health says America needs a new strategy for primary care.
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From top analysts to hospital board rooms, healthcare leaders have emphasized a consistent theme for 2023: an end-to-end approach to revenue cycle management (RCM). End-to-end capabilities featured prominently in the Everest Group’s recent Revenue Cycle...
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By Jonathan G. Wiik, Vice President, Health Insights, FinThrive
It’s about time: hospitals finally posted a positive margin in December according to Kaufmann Hall’s latest flash report. That’s just one piece of a generally optimistic outlook on the rest...
6 min read
Approximately 20% of the new drugs approved in the last several years have known racial and ethnic differences in disposition. Still, the most recent data snapshot on diversity and inclusion from the U.S. Food & Drug Administration revealed that 75% of...
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Health organizations are zeroing in on Social Determinants of Health, removing socioeconomic barriers to healthcare and social services in order to improve patient outcomes. In the process, they’re also improving the financial health of the entire...
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If we were designing the healthcare system from scratch, Brook Ward says most of us would have a clear vision for what it should look like.
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2022 was a tough year for healthcare providers… and patients. For providers, expenses outpaced revenue, driven up by the labor shortage, premium-priced outsourcing services and inflationary supply costs. For patients, job instability, insurance...
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By Jonathan G. Wiik, Vice President, Health Insights, FinThrive
New year, new data! While the numbers from the end of 2022 continue to show the same challenges faced throughout the year – negative margins, staffing issues, inflation, unpredictable...
7 min read
By Brian Urban, Head of Payer Marketing, FinThrive
The average healthcare patient account bounces back and forth between payers and providers multiple times before it gets anywhere near payment.That’s why the current state of revenue cycle management may...
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By Sherry Nardi, Solution Strategy Director, FinThrive
Maintaining a healthy chargemaster is a key component to preventing revenue leakage but can also be labor intensive and time-consuming. With thousands of ongoing line-item updates, limited staff and...
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By Jonathan G. Wiik, Vice President, Health Insights, FinThrive
As 2022 draws to a close, we reflect on one of the worst financial years for U.S. hospitals. The latest reports are showing the 10th straight month of negative margins, labor issues persist...
9 min read
For those who question the far-reaching impact of political determinants of health, Population Health Professor Geoffrey Roche recounts this story:
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By Jonathan G. Wiik, Vice President, Health Insights, FinThrive
2022 has been one of the worst financial years for hospitals1 and most US hospitals and health systems are in a tight spot, to put it mildly. Between lower volumes, staffing shortages,...
5 min read
For modern healthcare to realize its true potential, revenue cycle management needs a new vision. The future requires a connected and holistic approach that empowers the providers, payers and patients who make the healthcare economy. Current processes...
6 min read
At Becker’s 7th Annual HIT RCM Conference in Chicago, FinThrive’s Chief Innovation Officer John Yount was joined by Brad Tinnermon, VP of Revenue Cycle and Revenue Integrity at Banner Health, and Matt Leary, VP of Finance at Centura Health. Read on to...
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Amending your overall collections strategy—to focus more on total collections versus average cost to collect—can help ensure you get the best return on your investment.According to a recent survey from AHIMA, the average net patient revenue for US...
7 min read
Data shows that only 20% of a patient’s health outcomes are influenced by their access to and quality of healthcare. That leaves 80% to be determined by other factors, such as where we live, work, play, go to school, and get our groceries. These...
6 min read
As a health plan, you are likely familiar with the National Committee for Quality Assurance (NCQA). A government agency whose mission is to “work for better health care, better choices, and better health,” the NCQA offers a wide variety of programs for...
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It’s that time of the year: changing seasons, fresh starts, new relationships and a nice sprinkle of chaos. We’re not talking about going back to school – we’re talking open enrollment.
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Imagine if the power of health plans could truly be unleashed. If they were fully invested in improving the health of the lives they serve, connecting members to meaningful wellness tools, helping people navigate complex healthcare networks, supporting...
5 min read
FinThrive has been recognized as one of the Best Workplaces in Healthcare by Great Place to Work and Fortune. Our values –customer-centric, agile, reliable and engaged – guide us in everything that we do. These values lead us on the path to achieving our...
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The Great Resignation has hit the healthcare industry from all angles. The loss of clinical staff has hurt the frontline of many health systems.
However, what many do not realize is that revenue cycle teams are inundated with claims, denials and requests...
6 min read
A lot has changed with revenue management in the last three years, especially the transition from traditional onsite employees to remote employees, leading to persistent staffing gaps.
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With staffing shortages still on the minds of healthcare finance leaders, it’s important for hospitals and health systems to consider time and cost-savings technology options, such as robotic process automation (RPA). RPA can easily adapt to fluctuating...
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Healthcare continues to become increasingly complex. Member health outcomes and financial measures are managed by disparate systems that trap information in silos, causing inefficiency, introducing human error, and causing friction between members,...
5 min read
Our lives changed significantly during the pandemic—lost jobs, cross-country moves, pay cuts and lost or changed health insurance. Healthcare behavior also changed. A survey released by the Prevent Cancer Foundation found that 43% of people surveyed had...
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The benefits of automating your revenue management processes are clear. From reduced costs to enhanced care, happier patients to more satisfied staff, automation delivers measurable value at each stage of the revenue cycle.
While healthcare leaders...
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Today’s health care leaders know that tackling unchecked costs requires innovation and digital transformation. But where do you start? Automation has virtually infinite applications across the revenue cycle – where will it make the greatest impact?
We...
6 min read
The current state of healthcare is incredibly costly for providers, payers, and patients. In 2020, hospitals lost $42.7 billion to uncompensated care. They spent $500B on administrative costs, $395B on waste, and $90B on inflated pricing. Payment cycle...
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So much of our overall health is impacted by various socioeconomic factors, which don’t involve ever stepping foot into a doctor’s office, clinic or hospital. Social determinants of health—commonly referred to as SDOH—and healthcare utilization have an...
5 min read
Ongoing COVID-19 challenges and its emerging aftermath have left people struggling—financially, personally and socially. Especially those most vulnerable. Given how closely financial health is linked to overall wellness,1 it’s important to recognize that...
3 min read
Over the past 24 months, already-thin hospital margins were further exacerbated by COVID-19. Hospitals are seeing up to $50 million in revenue leakage per facility per year from underpayments from payers, poor claims management, denials, under and...
4 min read
For a hospital CFO, the COVID-19 pandemic shifted priorities and emphasized cost containment and innovation in reimbursement models. It has forced leaders to take a hard look at their revenue management processes. In fact, per a recent...
4 min read
In 2020, 47% of hospitals saw increases in bad debt and uncompensated care.1 Incomplete or inaccurate patient demographic information, an unverified primary payer, resource constraints and more contribute to this deficit. At a time when margins are...
4 min read
To improve patient financial experiences and protect profitability, healthcare financial leaders need a strategy that focuses on end-to-end revenue management.
3 min read
In 2020, hospitals across the U.S. saw their median operating margin drop by 55.6%.1 The Coronavirus Aid, Relief, and Economic Security Act (CARES) helped offset escalating expenses, but the pandemic hasn’t been the only factor contributing to ongoing...