Hospital Price Transparency: CMS Pushes for Standardization

R1 Regulatory Affairs & Regulatory Compliance TeamJanuary 3, 2024

In an era of increasingly expensive care, price transparency initiatives have become a significant aspect of the U.S. healthcare system. From the Transparency in Coverage (“TIC”) requirements for health insurers1  to the Good Faith Estimate requirements of the No Surprises Act (“NSA”) for scheduled services,2  ...

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A Perfect Storm: Agencies Collaborate on Medical Debt, Price Transparency, Charity Care

Kathryn Beard, JDAugust 17, 2023

Almost 40% of Americans recently reported they were deferring medical care due to the cost of treatment.1 This is particularly true for Americans with low incomes, who have reported cancelling treatment for even the most serious conditions due to an inability to pay for necessary services.

 

Financial ...

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Robust RCM Systems: Keys to Effective Coding, Billing and Collections

Jeff GruberJuly 25, 2023

Effective coding, billing and collection processes are vital to ensuring timely and accurate payment for practice services. In the absence of strong procedures and systems, you put your medical group's financial stability at risk.

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Minimize Claim Denials with Effective Denials Management

Lucy ZippleJune 8, 2023

Denial prevention and effective denial management strategies are key to maximizing the revenue potential for the healthcare services you provide to your patients. 

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Why Prior Authorization Reform Should Garner Provider Support

R1 Regulatory TeamApril 14, 2023

In the United States, prior authorization (“PA”) is a cost-containment tool utilized by payers to reduce payment for medically unnecessary or inappropriate patient care. Despite its laudable policy goals, the use of PA faces

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The Future of Good Faith Estimates Under the No Surprises Act

R1 Regulatory TeamJanuary 18, 2023

The No Surprises Act of the 2021 Consolidated Appropriations Act (“NSA”) established requirements for healthcare providers to deliver Good Faith Estimates (“GFEs”) for scheduled services or upon patient request. 

Key Takeaways: 

  1. Indefinite extension  of co-provider and co-facility enforcement ...

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Hospital Price Transparency: Lessons Learned, Best Practices

R1 Regulatory TeamDecember 19, 2022

Federal price transparency requirements for hospitals from the Centers for Medicare & Medicaid Services (CMS) provide patients with an unprecedented amount of insight into the costs for medical services.1  

 

In theory, more pricing information should ...

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Three Things Your Anesthesia Billing Company Should Be Doing

R1 RCMNovember 10, 2022

It's common for anesthesia practices to turn to anesthesia billing companies for revenue cycle support.  But is your billing company doing what it should be doing for your physician group?  

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Early Insights on Independent Dispute Resolution Under No Surprises Act

R1 Regulatory Affairs & Regulatory Compliance TeamSeptember 23, 2022

On August 19, 2022, the Departments of Health and Human Services (“HHS”), Labor, and the Treasury (“the Departments”) issued a Federal Independent Dispute Resolution Process Status Update.1 In the statement, the Departments reported that between April 15th and August 11th, 2022, providers initiated ...

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3 Ways Revenue Cycle Partnerships Produce Financial Sustainability

R1 RCMAugust 25, 2022

There is no doubt that many healthcare systems and practices are in a strenuous financial period. Organizations need to quickly identify opportunities to reduce costs and increase profitability, which is making them seriously consider

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