Topics
Reimbursement
Out-of-pocket costs rising even as patients transition to lower-cost care settings
Out-of-pocket costs rising for patients
Revenue Cycle Management
Hospital CEOs focus on revenue growth over cost containment, according to new survey
CEOs are focused on revenue over cost
Strategic Planning
A strategic framework for evaluating whether health system partnerships are achieving their goals
How health system partnerships can achieve their goals
Capital Finance
Precision medicine: Barriers to investment
Precision medicine: Barriers to investment
Supply Chain
Group purchasing organizations reduce supply costs by 13.1 percent
GPOs reduce supply costs by 13.1 percent
Accounting & Financial Management
Medical costs projected to increase 6% by 2020, says PwC
PwC: Medical costs up 6% by 2020
Budgeting
New clinical pathway for cancer patients leads to better outcomes, lower healthcare costs
New clinical pathway lowers healthcare costs
Quality and Safety
Quality standards framework can improve both clinical and financial performance in healthcare
How a healthcare quality workforce can better care, costs
Billing and Collections
Medical costs create hardships for more than half of Americans
Medical costs a hardship for most Americans
Claims Processing
BCBS Institute and Solera partner, pay SDoH organizations through outcomes-based medical claims
BCBS Institute, Solera, to pay organizations through outcomes-based claims
Workforce
Geisinger names Dr. Jaewon Ryu its new president and CEO
Geisinger names Dr. Jaewon Ryu its new president and CEO
Operations
Humana to integrate IntelligentRx into Epic's e-prescribing workflow
Humana to integrate IntelligentRx into Epic's e-prescribing workflow
Medical Devices
Apple is developing custom health information tracking chips
Apple is developing custom health chips
Hospital/physician relations
Wording in medical student evaluations differ by gender, minority status, revealing potential bias
Gender, minority bias revealed in med student evals
Construction & Facilities Management
Kaiser Permanente plunking down $900 million on new Oakland headquarters
Kaiser Permanente building $900M HQ in Oakland
Compliance & Legal
AMA files lawsuit to block law forcing physicians to give scripted information regarding abortion
AMA files lawsuit to block compelled speech regarding abortion
Policy and Legislation
Proposed solutions to surprise medical bills a growing social risk for the healthcare industry, says Moody's
Solutions to surprise medical bills: A social risk?
Community Benefit
Kaiser Permanente commits $1.65 million to California wildfire relief efforts
Kaiser Permanente commits $1.65 million to California wildfire relief efforts
Accountable Care
Oak Street Health invests only in value-based care
Oak Street Health invests only in value-based care
Acute Care
University of Chicago Medicine study shows need to enhance patient rest, evaluate overnight interruptions for better patient experience
University of Chicago Medicine study shows how to help patients rest for improved experience
Ambulatory Care
Medical schools, teaching hospitals account for 3% of US GDP, report shows
Med schools, teaching hospitals are 3% of GDP
Analytics
Innovaccer research shows how AI could improve cost of care models
Innovaccer research shows how AI could improve cost of care models
Business Intelligence
While the price of healthcare is growing, utilization is dropping and price variations persist, report says
HCCI: Price of healthcare is growing, utilization is dropping, price variations persist
ICD-10 & Coding
Physician practices examine risk adjustment coding in wake of federal lawsuits
Practices keeping close watch on risk adjustment coding
Meaningful Use
CMS overhauls meaningful use EHR program, renames it 'Promoting Interoperability'
CMS overhauls meaningful use as 'Promoting Interoperability'
Medicare & Medicaid
Coverage losses, confusion in Arkansas months after state implements Medicaid work requirements
Medicaid work requirements: Not working in AR?
Patient Engagement
Why health professionals need to be cautious on social media
Caution on social media important for providers
Pharmacy
Drug shortages cost hospitals close to $360 million annually in labor expenses
Drug shortages a $360M hit to hospitals
Population Health
Screenings for social determinants of health need to be tailored to clinics, BU finds
SDOH screenings need to be tailored for clinics
Risk Management
Hospital employees are clicking on phishing emails, and that's a problem, JAMA study shows
JAMA: Hospital employees are clicking on phishing emails
Telehealth
Telemedicine market expected to account for more than $38 billion by 2029
Telemedicine worth $38 billion by 2029
Mergers & Acquisitions
UnitedHealth Group acquires PatientsLikeMe
UnitedHealth Group acquires PatientsLikeMe
View more

Medicare Administrative Contractors (MACs)

In-depth

CMS revamps the Medicare program integrity manual to accelerate innovation, access to technology

CMS revamps the Medicare program integrity manual to accelerate innovation, access to technology

Reforms to the local coverage determination process will…

CMS relents, opens up smartphone-connected CGMs for reimbursement

CMS relents, opens up smartphone-connected CGMs for reimbursement

The Centers for Medicare and Medicaid Services will reverse a longstanding unpopular position…

Whitepapers

Global Innovators

Global Innovators

Healthcare digitization is still often perceived as being an endeavor on the level of the individual healthcare system or nation state. While…

The Evolution of Utilization Review and Its Impact on Revenue Integrity

The Evolution of Utilization Review and Its Impact on Revenue Integrity

Existing utilization review (UR) paradigms are no longer suitable for addressing the…

Latest News

October 3, 2018 | Susan Morse

CMS revamps the Medicare program integrity manual to accelerate innovation, access to technology

June 15, 2018 | Jonah Comstock

CMS relents, opens up smartphone-connected CGMs for reimbursement

May 2, 2018 | Susan Morse

HHS Secretary Alex Azar to Supreme Court: Time to rule on Medicare case that affects $4 billion

March 26, 2018 | Beth Jones Sanborn

Medicare overpaid $367 million for outpatient physical therapy in six-month stretch, OIG audit finds

November 28, 2016 | Beth Jones Sanborn

Two Midnight rule helped slash improper payments for inpatient hospital claims by 58 percent, CMS says

June 9, 2016 | Susan Morse

CMS delays review of short stay patient claims under two midnight rule

November 2, 2015 | Susan Morse

CMS cements 'physician judgment' exception in two-midnight policy

VIEW ALL NEWS

MostPopular

Anthem accelerates start for PBM IngenioRX

Anthem accelerates start for PBM IngenioRX

List: 769 hospitals fined for medical errors, infections

List: 769 hospitals fined for medical errors, infections

See the first star ratings for home health

See the first star ratings for home health

Optum: UnitedHealth's secret weapon

Optum: UnitedHealth's secret weapon

List: CMS 2019 Star ratings show Kaiser on top

List: CMS 2019 Star ratings show Kaiser on top

Report reveals cost of high-deductible plans on consumers

Report reveals cost of high-deductible plans on consumers

Senate committee proposes massive bill to lower healthcare costs

Senate committee proposes massive bill to lower healthcare costs

News

Once-failing hospitals say accountability, transparency key to surviving fallout from failing patient safety grades

Once-failing hospitals say accountability, transparency key to surviving fallout from failing patient safety grades

When Leapfrog released their Spring 2016 patient safety grades recently, 15 hospitals got slapped with a very public 'F' grade casting a spotlight on them that no institution wants. But with more patients weighing public hospital grades, experts, as well as a few…

Analyze this: Health systems, health plans get to the core of big data

Analyze this: Health systems, health plans get to the core of big data

Pamela Peele knows that people who subscribe to cooking magazines have a much higher risk of going to the emergency room. But how she knows that is a whole other story.

Healthcare mergers and acquisitions in 2016: Running list

Healthcare mergers and acquisitions in 2016: Running list

While 2015 was a record-breaking year in healthcare mergers and acquisitions, 2016 saw more change as organizations across the industry adjust and adapt to the evolving financial landscape.

Whitepapers

Gaining Actionable Insight into Financial Systems and Areas Impacting the Revenue Cycle

Gaining Actionable Insight into Financial Systems and Areas Impacting the Revenue Cycle

Hospital systems across the country are looking to streamline their billing and collection processes to become more efficient and better compete in their markets. The challenge many face is how to turn the data that's already flowing through financial systems into…

Credible, Defensible Estimates

Credible, Defensible Estimates

In healthcare, every interaction with the patient matters. Especially in today’s environment of continuous improvement, efforts have been concentrated on coordination among providers, the patient care experience and quality outcomes – all laudable goals.

Clinical Quality Measures 101

Clinical Quality Measures 101

Although quality-reporting programs such as meaningful use provide incentives to help providers implement and use electronic health records (EHRs) to collect and report on clinical data, practices often need help deciding what data to collect, which measures to…