Strategic and programmatic approach to transform team performance
Align critical metrics to your revenue goals
Proprietary data-driven review program to optimize patient admission status
We defend your patient care choices to secure fair reimbursement
Root-cause analysis and strategy to combat payer tactics
The New Economics of Healthcare Reimbursement What’s Driving the Pressure on Healthcare Reimbursement Models? The traditional healthcare reimbursement model is under pressure and health system leaders know it. National health expenditures grew 7.2% in 2024, reaching...
Root Cause to Revenue: Winning the Battle Against DRG Downgrades 07.29.2026 11:00 AM PT Executive Vice President Vice President, Denials Management ServicesHospitals and health systems face mounting revenue challenges from denials to evolving payer tactics, making...
Hidden Denials: The Revenue Loss Your 835 Will Never Show You Most health system revenue cycle leaders believe they have a handle on their denials problem. They track denials rates. They report on overturn percentages. They run monthly dashboards that show the total...
On November 2, 2021, CMS released the anticipated CY 2022 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Final Rule (CMS-1753-FC), finalizing this year’s Medicare payment rates for hospital outpatient and ASC as well including regulatory guidance regarding several high profile policies for hospitals providing outpatient services. CMS evaluated industry feedback to the proposed modifications, including halting the elimination of the Inpatient Only list (IPO), broadening the impact of the Hospital Price Transparency Rule, and other updates.
Additional Funds, Delay in Reporting Requirements, and Audits The Provider Relief Fund (PRF) was established when Congress passed the Coronavirus Aid, Relief, and Economic Security (CARES) Act to support American families, workers, and healthcare providers in the...
By Jerilyn Morrissey, MD Regardless of who your team reports to on the organization chart, there is no getting around the fact that Utilization Management (UM) is part of the clinical revenue cycle of your organization. Embracing that concept may challenge your...
