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
The Power Behind the HFMA Peer-Reviewed Status
Abby BirchMarch 3, 2023
Dear Health Leaders,
In the world of revenue cycle ...
Executive Shares Insights on RCM Outsourcing
R1 RCMMarch 1, 2023
If you’re like most healthcare executives, you've probably spent countless hours thinking about a host of challenges including razor thin margins, the labor market, and how to improve the patient experience. You’ve probably read articles about RCM outsourcing, watched webinars and analyzed data about the impact it can have. Maybe you’ve even ...
A Post-Mortem on Medical Necessity Criteria – Not So Fast
Dr. Ronald HirschFebruary 24, 2023
The proposal from the Centers for Medicare & Medicaid Services to codify the requirement that all Medicare Advantage plans use the Two-Midnight Rule for determining admission status of all patients has some talking that the use of commercial criteria will become obsolete. ...
Evaluating RCM Technology Through Three Different Stakeholder Lenses
R1 RCMFebruary 1, 2023
RCM outsourcing and technology go hand-in-hand. The robust technology offered by outsourcing partnerships can offer streamlined workflows, intelligent automation, and unparalleled accuracy, all of which can lead to reduced costs and increased revenue collections. These benefits are a big reason why
RACmonitor: Warning: Medicare Rates Up in 2023
Dr. Ronald HirschJanuary 27, 2023
EDITOR’S NOTE: Listen to Dr. Ronald Hirsch’s live reporting Monday on Monitor Mondays with Chuck Buck at 10 Eastern.
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:
- Indefinite extension of co-provider and co-facility enforcement ...
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 ...
The Benefits of RCM Global Delivery: Five Myths Busted
R1 RCMDecember 13, 2022
While the healthcare industry continues to climb its way out of a pandemic, it’s also facing unprecedented challenges, including severe labor shortages and shrinking margins. What if there was a global delivery model that could help the industry during this challenging time?
Revenue cycles challenged by mandates of No Surprises Act
Susan MorseDecember 5, 2022
The No Surprises Act has reportedly done its job in preventing an estimated nine million surprise medical bills since going into effect at the start of this year, ...
