Revenue Cycle Management

RCM: The Art of Compassionate Billing—and Why You Should Put Patients First

Florian Otto Co-founder and CEO, Cedar A woman is charged $22,000 for stitches and scar repair after being bitten by a dog. A man gets hit with a $30,000 bill for ACL reconstruction surgery. People around the country receive Covid-19 test bills ranging from a few dollars to more than $1,000—and to make things worse, …

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8 Key Healthcare Revenue Cycle Benchmarks to Increase Productivity

What You Should Know: – AKASA™, an automation company for healthcare revenue cycle management,  released a report titled, “New Productivity Benchmarks For The Healthcare Revenue Cycle” that includes the first-ever publication of the average time it takes health system staff to complete critical tasks within revenue cycle operations based on AKASA’s proprietary data. – These …

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Healthcare Automation Most Urgent Need to Improve Patient Care, Report Finds

What You Should Know: Half of the healthcare administrative staff report seeing an increase in the amount of manual data entry in the past 12 months — and 92% of clinicians agree that too much time spent on administrative tasks is a major contributor to healthcare worker burnout. This and other findings are revealed in …

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Edifecs Acquires Talix to Expand Risk Adjustment Solution

What You Should Know: – Edifecs, a global health IT provider announced it is acquiring Talix, a SaaS IT company, to expand Edifecs’ reach in the encounter management and risk adjustment space. Financial details of the acquisition were not disclosed. – The integration of Edifecs’ and Talix’s technologies will create an expanded risk adjustment solution …

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Zelis Acquires Healthcare Transparency Leader Sapphire Digital

What You Should Know: – Bain-backed digital health payments company, Zelis today announced the acquisition of Sapphire Digital, a healthcare consumer-centered pricing and navigation software company serving more than 100M members. Financial details of the acquisition were not disclosed. – Sapphire’s platform offers tools for provider search and selection, quality ratings and reviews, pricing data, …

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How tech can help solve the overpayments problem in healthcare RCM

When CMS overpays for services, providers and commercial payers are responsible for paying the agency back, and at times, they are on the hook for millions of dollars. But technology can help healthcare stakeholders catch the mistakes that lead to overpayments, thereby reducing unnecessary costs.

TransUnion Explores Sale of TransUnion Healthcare, Sources Say

What You Should Know: – Credit reporting agency TransUnion is currently evaluating the sale of its revenue cycle management subsidiary, TransUnion Healthcare, PE Hub first reports. – Sources report TransUnion Healthcare at an initial valuation of $1.9B to $2.2B with approximately $100M of earnings before interest, taxes, depreciation, and amortization (EBITDA). – TransUnion Healthcare makes …

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Cooper University, Nuance Expand Dragon Ambient eXperience Deployment to 475 Physicians

What You Should Know: – Nuance Communications and Cooper University Health Care announced a strategic collaboration to expand Cooper’s deployment of the Nuance Dragon Ambient Experience (DAX) to 475 physicians based on previous deployment success. This ambient clinical intelligence solution will expand upon Cooper’s ability to enhance patient experiences, expand access to care, and advance …

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Olive Launches In-House Venture Studio for Digital Health Startups

Olive Launches In-House Venture Studio for Digital Health Startups What You Should Know:  – Olive, the $4B healthcare automation company, today announced Olive Ventures, a new in-house venture studio that works hand-in-hand with early-stage entrepreneurs to create digital health companies through Olive’s platform.  – Olive Ventures offers visionaries a secure, compliant tech environment (i.e. Olive’s …

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Delta Variant Raises New Uncertainties for Hospitals Nationwide

What You Should Know: – In May, U.S. hospitals, health systems, and physician groups were beginning to recover from COVID-19’s impact on their operations, but the dramatic spread of the Delta variant and an increase in COVID-19 cases and hospitalizations caused new setbacks, according to two reports from Kaufman Hall. – Hospitals and health systems …

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How Built-In Financial Services Can Help Healthcare Providers Rebound Post-Pandemic

Tarun Bhasin, CEO of Kunai While their staff grappled with the medical toll of the COVID-19 pandemic, healthcare provider’s financial struggles went largely uncovered. But a 2021 KaufmanHall report revealed that hospital operating margins lag well behind pre-outbreak levels—a gap even the CARES Act assistance couldn’t help bridge. To make matters worse, cash flow has …

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Provider Adoption of Automated Revenue Cycle Operations On The Rise

What You Should Know: – 78 percent of health systems are currently using or are in the process of implementing automation in their revenue cycle operations, according to recent survey results from AKASA, a South San Francisco-based revenue cycle management automation company. The key findings signal automation in healthcare is no longer an emerging trend …

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M&A: AmerisourceBergen Acquires Fintech Solution FirstView Financial

What You Should Know: – Today, global healthcare company AmerisourceBergen announced it has acquired FirstView Financial (FirstView), a fintech solutions provider that delivers innovative digital payment processing services to support patient affordability and access programs, pharmacy and provider networks, and payors and plan administrators. – The addition of FirstView to AmerisourceBergen’s existing suite of manufacturer …

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Streamline Health Acquires RCM Consulting Firm Avelead for $20M

What You Should Know: – Streamline Health Solutions, Inc., a provider of the eValuator Revenue Integrity Program to help healthcare providers proactively address revenue leakage and compliance exposure, announced the acquisition of Avelead Consulting, LLC (“Avelead”), a provider of solutions and services to improve revenue integrity for healthcare providers. – Financial terms of the acquisition include closing cash and …

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Olive Selects AWS as Its Preferred Cloud Provider to Create the Internet of Healthcare

What You Should Know: – Olive, the AI healthcare company, announced today the adoption of Amazon Web Services, Inc. (AWS) as its preferred cloud provider, now leveraging AWS’s computing capabilities to improve healthcare efficiency and reduce costs for patients and organizations. – Olive’s workflow automation solution will run on AWS to connect the disparate systems …

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Kareo Acquires RPA-Powered Medical Billing Provider PatientlySpeaking

What You Should Know: – Kareo, a provider of cloud-based clinical and business management software solutions for independent healthcare practices and billing companies, today announced the acquisition of PatientlySpeaking, a process automation technology company for billing companies and medical practices. – Together with Kareo’s intuitive billing platform, PatientlySpeaking provides an integrated data connection for billing …

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Olive Enters Clearinghouse Market with Acquisition of Healthcare IP

What You Should Know: – Olive, a healthcare automation company today announced the acquisition of Healthcare IP, an integrated partner of healthcare provider and payer organizations, advocating data transparency and user experience in the revenue cycle. Financial details of the acquisition were not disclosed. – Healthcare IP is a clearinghouse that has been streamlining payment …

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Tegria, Cedar Partner to Humanize the Patient Financial Experience

What You Should Know: – Tegria, a Seattle-based healthcare technology, and services company, and Cedar, a New York City-based healthcare financial technology platform, announced the formation of a strategic partnership. The partnership will bring Cedar’s consumer-facing financial engagement platform to Tegria customers and deliver Tegria’s robust revenue cycle management expertise to Cedar’s extensive client base, …

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Relatient Merges with Patient Access Platform Radix Health, Raises $100M+

Anup Lakare co-founder of Radix Health, Michele Perry CEO of Relatient and Arun Mohan co-founder and CEO of Radix Health (L to R) – Today, Relatient, Inc., the leading SaaS-based, patient engagement platform, announced the signing of a definitive agreement to merge with Radix Health, a data-driven platform that helps medical practices and hospital groups optimize …

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Cedar Appoints Krishna Rao as Chief Financial Officer

What You Should Know: – Cedar, a New York City-based innovative healthcare financial technology platform, announced it has named Krishna Rao as Cedar’s first Chief Financial Officer (CFO). – Rao brings over 15 years of experience growing businesses, most recently serving as Global Head of Corporate and Business Development for Airbnb. In this role, he …

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3M Taps Waystar to Automate Revenue Capture Processes for its Clients

What You Should Know: – Healthcare payments company Waystar, today announced a partnership with 3M Health Information Systems to help 3M clients improve their payment operations. – As part of the strategic partnership, 3M will leverage Waystar’s AI-powered solutions that will allow providers, health systems, and hospitals to improve operational efficiency and compliance and collect …

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VisiQuate Lands $50M to Expand AI-Powered RCM Automation Solution

What You Should Know: – VisiQuate, Inc., a Santa Rosa, CA-based provider of advanced analytics and AI-powered automation today announced a new $50 million equity investment from Sixth Street Growth. – Founded in 2009, VisiQuate, Inc.’s user-friendly data management and analytics solutions let virtually anyone in a healthcare organization explore complex data from multiple sources to …

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XFIN Acquires Radiology Revenue Cycle Provider CMS – Health M&A

What You Should Know: – Health IT company XIFIN announced the acquisition of Computerized Management Services (CMS), a provider of comprehensive revenue management services for hospital-based radiology groups and imaging centers. CMS provides a comprehensive suite of outsourced financial services focused on maximizing radiology client revenue and cash flow streams. Its services leverage strong technology systems and analytics, including revenue cycle, strategic consulting, credentialing and coding.  – This …

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Olive Secures $400M At A $4B Valuation to Support New Instant Claim Payment Solution

What You Should Know: – Today, healthcare automation company Olive, today announced a $400M in funding round led by Vista Equity Partners with additional investment from the Base10 Partners Advancement Initiative. Olive, a provider of AI powered workforce purpose-built for healthcare, has now secured $832 million in financing since March 2020, and $902 million since …

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Iodine Acquires Clinical Documentation Solution ChartWise – Health M&A

What You Should Know: – Iodine Software, a healthcare AI company, today announced it has acquired clinical documentation integrity company ChartWise Medical Systems. Financial details of the acquisition were not disclosed. – The acquisition comes just two weeks after Iodine completed an acquisition of Artifact Health, a mobile-based physician query platform that was in 300+ hospitals. Now, after both acquisitions, Iodine will …

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Bassett Healthcare Network outsources IT, RCM operations to Optum

The New York-based rural health system has entered into a collaboration to outsource its IT and revenue cycle management operations to Optum. Further, about 500 Bassett employees, who currently perform those functions, will be given the opportunity to transition to Optum.

Olive, ASUS Partner to Bring AI-Assisted Medical Coding to 775+ Hospitals

What You Should Know: – Olive and ASUS announced their partnership to bring AI-assisted medical coding to over 775 U.S. hospitals. Olive will bring ASUS Miraico, the AI medical coding assistant, to healthcare providers via the Olive Helps platform. – The addition of Miraico to the Olive Helps system will allow the AI to analyze clinical terms in medical records and automatically recommend relevant and accurate ICD-10 codes. This partnership will provide much faster and more accurate medical coding, as well as …

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Iodine Software Acquires Physician Query Platform Artifact Health – Health M&A

What You Should Know: – Iodine Software, a leading healthcare AI company, today announced it has acquired physician engagement platform company Artifact Health. Financial details of the acquisition were not disclosed. – The acquisition brings together two industry leaders and expands Iodine’s clinical predictions and insights platform beyond clinical documentation improvement (CDI) teams to directly engage …

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Mednax Taps R1 for Enterprise Revenue Cycle Management Services

What You Should Know: – R1 RCM Inc., a leading provider of technology-driven solutions that transform the patient experience and financial performance of healthcare providers, and Mednax, Inc., a national medical group specializing in prenatal, neonatal and pediatric services, have entered into an agreement that will make R1 the primary provider of enterprise revenue cycle …

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Cedar Acquires OODA Health for $425M to Power Healthcare Financial Tech Platform

Cedar Acquires OODA Health for $425M What You Should Know: – Cedar, a healthcare financial technology platform, today announced it has entered into a definitive agreement to acquire OODA Health, a healthcare technology company focused on improving the healthcare administrative experience with payers and providers, for $425M. – By bringing together providers and payers onto …

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TriHealth Taps Olive to Deploy On-Site AI Command Center Across Enterprise

What We Should Know: – Olive and TriHealth announced their partnership to deploy Olive’s on-site AI command center, the AlphaSite, across TriHealth’s enterprise. The AI investment will begin with automating revenue-cycle related tasks, such as claims status checks while delivering increased ROI to the TriHealth network.  –  The AlphaSite program — the creation of an on-site AI command center — allows Olive to take a 360-degree approach to transform the entire healthcare …

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The Future of Revenue Integrity: From Reactive to Predictive – RCM

Vasilios Nassiopoulos, Vice President of Platform Strategy and Innovation, Hayes Healthcare organizations have witnessed an explosion of new opportunities to extract value from the industry’s treasure trove of data in recent years, with success stories related to using advanced technology such as artificial intelligence (AI) and machine learning found in every sector.  Revenue integrity is …

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R1 Acquires Patient Financial Engagement Platform VisitPay for $300M

What You Should Know: – Today R1 announced they will acquire patient financial engagement company VisitPay for $300 million in cash, leading the charge in overhauling the patient experience in the area with the most pain points – from surprise billing to price transparency. The acquisition marks R1’s third acquisition in the last year, transitioning …

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Why the Digital Front Door is Critical to the Healthcare Revenue Cycle

Joel French, EVP of Patient Experience at R1 RCM, Inc. The COVID-19 crisis has upended many of our traditional business procedures and processes. However, because digital transformations were well underway before the pandemic, the shift to remote work and contactless consumer self-service was swift. In healthcare, digital strategies that were expected to take 10 years …

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Leveraging comprehensive consumer data to improve healthcare collections

Collections were tough even before COVID-19 hit. Provider’s bottom lines were already strained, and the high-deductible trend continued, putting patients on the hook for a bigger chunk of their medical bills. A highly volatile – but improving – employment environment hasn’t helped, and some patients’ ability to pay hasn’t kept pace with their growing financial …

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Medchart Raises $17M to Simply The Request of Medical Records for Patients, Businesses

What You Should Know: – Medchart, a Dallas-based cloud-based platform powering patient-authorized information for businesses, researchers, and consumer services announced it has raised $17M in seed and Series A funding led by Crosslink Capital and Golden Ventures, with additional funds from Vast Ventures, Union Ventures, iGan Partners, Stanford Law School, and hip hop icon Nas, …

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Navigating the complexities of health coverage and reimbursement beyond the pandemic

Product featured in this article: Coverage Discovery As of the end of March 2021, more than 53 million Americans have been fully vaccinated, allowing for cautious optimism as we prepare for the next phase of the COVID-19 journey. Unfortunately for pharmacists, the vaccination program has compounded many of the challenges of the last 12 months. …

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Q1 2021 Health IT/Digital Health PC/VE, M&A, IPOs/ SPACs Activity

The first quarter of 2021 has been one of investor optimism as the vaccine rollout continues ahead of expectations and economic activity begins to accelerate in response.  Within the Health IT industry, the already strong investment and M&A trends seen in 2020 have only accelerated.  Over the course of the quarter, we observed $7 billion in private …

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Cardinal Health and Deep Lens Collaborate for AI-based Oncology Clinical Trial Matching

What You Should Know: – Today, Deep Lens and Cardinal Health announced a strategic collaboration that will integrate Deep Lens’ AI-based clinical trial matching solution, VIPER, into community-based oncology practices throughout the Cardinal network. VIPER will be a part of Cardinal Health’s new Navista advanced suite of technology solutions designed to help oncologists improve outcomes, …

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3 Barriers Stalling AI Adoption in Revenue Cycle Management

Kenya Smith, Healthcare Solution Marketing Manager at ABBYY AI technology is quickly evolving and already surpassing human decision-making in certain instances; sometimes, in ways, we can’t explain. While many are alarmed by this, AI is producing some of the most effective and dramatic results in business today.  Adoption of AI in healthcare is growing, but …

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Omega Healthcare Acquires himagine Solutions to Expand Global Delivery Model

What You Should Know: – Omega Healthcare, a provider of outsourced revenue cycle management and other healthcare support services, today announced the acquisition of himagine Solutions, a St. Louis based provider of medical coding and registry services. The transaction expands the service capabilities and geographical footprint of both companies, enhancing the ability to service clients globally. – Through this acquisition Omega Healthcare will …

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Lawsuit: Cerner systems’ failure drove Astria Health into bankruptcy  

The Washington-based health system has filed a lawsuit against EHR giant Cerner saying it intentionally misrepresented its products and services. Cerner’s systems did not operate as promised, leading to severe cash collection issues at Astria Health and forcing it into bankruptcy in 2019, the suit alleges.

AKASA Raises $60M to Automate Revenue Cycle Operations for Health Systems

What You Should Know: – AKASA (formerly known as Alpha Health), a South San Francisco, CA-based Unified Automation™ company for revenue cycle management in healthcare, announced it has raised $60 million in its series B round of funding. – Founded in 2018, AKASA uses the same machine learning approaches that made driverless cars possible to …

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Greenway Health Launches Customizable RCM Solution

What You Should Know: – Greenway Health announced the launch of its new Greenway Revenue Services offering, GRS Select™, a customizable revenue cycle management (RCM) offering designed to meet the unique, individualized needs of healthcare practices as they rebuild and improve the profitability of their practices a year after the onset of the COVID-19 pandemic. …

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Waystar Launches Price Transparency Solutions to Meet Consumer Demand

What You Should Know:  – Waystar, a provider of healthcare payments software, today announced the addition of the Text Statements feature to its suite of payment tools. This new solution enables patients to easily view and pay medical bills directly from their smartphone, bringing transparency and convenience to the patient financial experience – a long-standing …

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How to Optimize Your Healthcare Practice with Advanced Technology Solutions

Terrence D. Sims, President of Strategic Growth and Marketing, Raintree Systems As COVID-19 continues to influence patient behaviors and causes providers to reevaluate how they operate their businesses, healthcare practices all around the world started looking for solutions that emphasize clinical efficiencies, elevate patient revenue cycle management, as well as feature enhanced reporting, and analytics …

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Vytalize Health Acquires Patient Financial Experience Platform MedPilot

What You Should Know: – Vytalize Health acquires patient financial experience platform MedPilot to accelerate data-driven engagement technology to its ACO’s Medicare population. – An alumnus of the Cedars-Sinai Accelerator, MedPilot’s platform has already helped over 1 million patients to date and boasts a 97% patient satisfaction score.   Vytalize Health, a leading provider of value-based …

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Can AI Pave the Path to Reducing Physician Burnout?

Abboud Chaballout, Founder of Diagnoss The timing couldn’t be more critical for us to start making serious headway to reduce the growing problem of burnout among America’s physicians. In 2018, physician burnout was already at an alarming 42%, but that number is growing as COVID-19 cases surge around the country.  While we are at a hopeful place …

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Healthcare Can Save $16.3B Automating Administrative Transactions, Report Finds

What You Should Know: – Each year, the US healthcare industry spends $39 billion on 9 administrative transactions, according to a new report from CAQH. – The 2020 CAQH Index also uncovered that by automating these transactions, the industry could save $16.3 billion annually–a 42% cost reduction. CAQH, released the eighth annual report measuring the …

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How Automation is Key to the Future of Healthcare Operations

Giri Rajaiah, Executive Leader, Vice President, Healthcare & Life Sciences, DISYS As the saying goes, necessity is the mother of invention. A similar correlation is seen in the quest to leverage innovation and out-of-the-box thinking to address key problems facing the healthcare industry. The ongoing COVID-19 pandemic has brought the immense pressure the U.S. healthcare …

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Medsphere Acquires Healthcare Relationship Management Platform Marketware

What You Should Know: – Medsphere, a provider of affordable clinical IT systems and support services announced it has acqauired healthcare relationship management and analytics company Marketware. Medsphere Systems Corporation today announced the acquisition of Marketware, Inc., a leading developer of robust software tools focused on managing healthcare relationships and analyzing a wide variety of …

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Intelligent Automation of the Revenue Cycle: How an Integrated Platform Approach Yields Financial Results

Sean Barrett, Senior Vice President, Product and Digital Transformation, R1 RCM Healthcare provider networks are experiencing enormous pressure to manage financial margins and invest in contactless patient experiences. With overall financial losses projected to exceed $323 billion as a result of COVID-19, a projected $200 billion in administrative waste due to revenue cycle inefficiencies, and …

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4 Quick Tips for Getting COVID-19 Claims Paid Promptly

Lillian Phelps, Sr. Director of Product Management, Availity As the COVID-19 pandemic has gripped the world, many providers have adopted an all-hands-on-deck approach and mentality for treating COVID-19 patients, stretching their resources to the breaking point.  We have heard about the frontline heroes who have sacrificed their own health and safety to treat patients and, …

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UnitedHealth Group Acquires Change Healthcare to Combine with OptumInsight for $13B

What You Should Know: – UnitedHealth Group has reached an agreement to acquire Change Healthcare in a deal valued at more than $13 billion, marking the first major acquisition of 2021. – Change Healthcare will be combined with OptumInsight to advance a more modern, information, and technology-enabled healthcare platform. UnitedHealth Group’s has reached an agreement …

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2020’s Top 20 Digital Health M&A Deals Totaled $50B

Teladoc Health and Livongo Merge The combination of Teladoc Health and Livongo creates a global leader in consumer-centered virtual care. The combined company is positioned to execute quantified opportunities to drive revenue synergies of $100 million by the end of the second year following the close, reaching $500 million on a run-rate basis by 2025. …

2020’s Top 20 Digital Health M&A Deals Totaled $50B Read More »

Gleaning Insights for COVID-19: Why Claims and Clinical Data Matter

Emad Rizk, M.D., President, CEO & Chairman of the Board, Cotiviti As 170 research teams race to develop a vaccine for COVID-19, some that are in late-stage approvals have seen recent progress, but it is still not yet clear when a vaccine will become widely available. Until then, healthcare organizations continue to rely heavily on …

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What is Revenue Cycle Management?

There is no question that providers’ bottom line has been hit hard this year, and a new surge in COVID-19 is bound to threaten hospital finances once again. As healthcare providers look to supercharge their payment velocity during these uncertain times, it’s worth taking a step back to examine the revenue cycle management process as …

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M&A: Olive Acquires AI Prior Authorization Company Verata Health

What You Should Know: – On the heels of $225.5 million dollars in funding and a $1.5B valuation this week, Olive today announced its acquisition of Verata Health to create a combined AI prior authorization solution for providers and payers under the Olive name. – Prior authorization is a $31 billion dollar issue in healthcare, …

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Healthcare M&A: DAS Health Acquires Randall Technology Services

What You Should Know: – DAS Health Ventures acquires healthcare and managed IT company Randall Technology Services (RandallTech). – This acquisition adds Allscripts® PM and EHR solutions to the DAS portfolio of supported products, and DAS Health has now added additional staff in Texas that will create opportunities for greater regional support of its entire …

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Hospital Sustainability Demands that Revenue Integrity Move Front and Center

Vasilios Nassiopoulos, VP of Platform Strategy and Innovation, Hayes Razor-thin operational margins coupled with substantial and ongoing losses related to COVID-19 are culminating in a perfect storm of bottom-line issues for U.S. hospitals and health systems. A study commissioned by the American Hospital Association (AHA) found that the median hospital margin overall was just 3.5% pre-pandemic, and …

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M&A: Medsphere Systems Corporation Acquires Micro-Office Systems

What You Should Know: – Medsphere acquires Micro-Office Systems (MOS), developer of systems integration and communication tools. MOS will retain its name and will serve as a division of Medsphere moving forward. Medsphere Systems Corporation today announced the acquisition of Micro-Office Systems (MOS) in a move that will even further enhance the value and usability of Medsphere’s affordable …

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Nuance Sells Off Transcription and EHR-Go-Live Services Businesses to DeliverHealth

What You Should Know: –   Nuance announced that it’s planning to sell two sections of its healthcare business – Health Information Management (HIM) and Electronic Health Record (EHR) Go-Live Services – to a new independent company, called DeliverHealth, in early 2021. – Nuance will be a minority shareholder of DeliverHealth and continue to provide its …

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AMA Unveils 2 Vaccine-Specific CPT Codes for Coronavirus Immunizations

What You Should Know: – The American Medical Association (AMA) published an update to the Current Procedural Terminology (CPT®) code set that includes new vaccine-specific codes to report immunizations for the novel coronavirus (SARS-CoV-2). – The new Category I CPT codes and long descriptors for the vaccine products 91300 and 91301 for better tracking, reporting, …

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How Yale-New Haven Uses IPA in Revenue Cycle to Tackle Inefficiency

As the pandemic heads toward a second year with no further financial stimulus guaranteed, hospitals and health systems are seeking ways to reduce costs and improve revenue cycle performance. Intelligent process automation (IPA) is an emerging solution designed to optimize operations and increase productivity through a combination of process modeling, process automation, and artificial intelligence.  …

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Q&A with Experian Health senior director of data compliance on CMS updates for Medicare ABN forms

As every healthcare executive knows, a healthy revenue cycle relies on precise paperwork. That’s why all Medicare providers should be paying close attention to the revised medical necessity form, which will be mandatory starting January 1, 2021. Failure to use the new Advance Beneficiary Notice of Non-coverage (ABN) form could lead to denied claims, financial …

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Humana Taps Cohere Health to Modernize Prior Authorizations for Musculoskeletal Treatment

What You Should Know: – Cohere Health partners with health insurer Humana to modernize the prior authorization process for musculoskeletal treatment across 12 states. – In addition, the company has closed an additional $10M in funding led by Flare Capital Partners and Define Venture, bringing the company’s total funding to $20M. Health insurer Humana has …

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Impact of COVID-19: 2020 State of Healthcare Performance Improvement Report

What You Should Know: – Nearly three-quarters of hospital leaders are either moderately (52%) or extremely (22%) concerned about the financial viability of their organizations without an effective treatment or vaccine for COVID-19, according to a new report from Kaufman Hall entitled, “2020 State of Healthcare Performance Improvement Report: The Impact of COVID-19” – One-third …

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Innovaccer Unveils Risk Adjustment Solution For Improved Coding Accuracy

What You Should Know: – Innovaccer unveils new risk adjustment solution to help providers better segment their population to refine the risk scoring process and improve coding accuracy and efficiency, thereby improving performance on risk-based contracts. – The solution utilizes Artificial Intelligence (AI) and Natural Language Processing (NLP) to make risk predictions. Innovaccer, Inc., a …

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AMA Adds New CPT Codes Multi-Virus Tests to Detect COVID-19 and Flu

What You Should Know: – AMA announces new CPT codes for multi-virus tests to detect COVID-19 and flu for immediate use.  The American Medical Association (AMA) today published an update to the Current Procedural Terminology (CPT®) code set that includes new code additions and editorial revisions for reporting medical services sparked by the public health response to …

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Intermountain to Deploy AI-Powered Digital Assistants Across Clinically Integrated Network

What You Should Know: – Intermountain Healthcare announced it will scale Notable’s AI-driven platform across the health system’s clinically integrated network to support thousands of providers, automate administrative workflows, streamline the check-in experience for patients, and simplify provider follow-up. – The Notable Platform uses intelligent automation to identify and engage more patients in need of …

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Getting Beyond the Telehealth ‘Stop-Gap’ Mentality

Roland Therriault, President, InSync Healthcare Solutions Since COVID-19 emerged as a major health threat, virtual care has taken off. As many as 46% of patients reported in late April that they had used telehealth to replace a canceled healthcare visit in 2020, while 48% of physicians said they had started using telehealth to treat patients.   …

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TrustHCS, Visionary RCM, T-System, RevCycle+ Merge to Form New Entity CorroHealth

What You Should Know: – CorroHealth – a newly-formed entity – combines the services and technologies of TrustHCS, Visionary RCM, T-System, and RevCycle+. – Under this new entity, CorroHealth is committed to helping clients navigate regulatory compliance complexities, ease physician burdens and improve financial outcomes. Today, four revenue cycle management services and technology organizations have …

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Robotic Process Automation: The future of healthcare revenue cycle management

As RPA’s value for revenue cycle continues to be explored, leaders need to go beyond the hype and determine a practical path to innovation that takes into account the organization’s capacity for innovation and the road map that will best take the organization to its desired digital destination.

Designing A Digital Experience to Drive Revenue and Patient Engagement

Bill Krause, VP and GM, Digital Experience and Consumer Engagement at Change Healthcare With the rise of healthcare consumerism, people are looking to hospitals, health systems, and physician practices to deliver the same user-friendly, digital experiences they receive from other industries. A recent survey found that more than 80% of consumers surveyed believe “shopping for …

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Report: Modern Revenue Integrity Solutions Driving Payment Performance

What You Should Know: – New Chilmark Research report on revenue integrity in healthcare reveals a transitional market making strides to address the new burdens of modern care economics. – The ongoing COVID-19 public health emergency underscores the imperative need for automation and reduced administrative costs even clearer. Revenue cycle has and continues to be one of …

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Waystar Acquires Medicare RCM Company eSolutions at $1.3B Valuation

What You Should Know: – Revenue cycle management provider Waystar acquires eSolutions, a provider of Medicare and Multi-Payer revenue cycle management, workflow automation, and data analytics tools at a $1.3B valuation. – The acquisition will create the first unified healthcare payments platform with both commercial and government payer connectivity, resulting in greater value for providers. …

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Top 5 RCM Challenges for Healthcare Executives in the COVID-19 Era and Beyond

Brian Robertson, CEO at VisiQuate, There have been many memorable “where were you?” events since the 21st century began. But few can match the COVID-19 pandemic, at least from a healthcare perspective.  The effect on healthcare (and healthcare executives) has been particularly profound since our industry is in the center of everything. From the search for …

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T2 Tech Group Acquires Remote Patient Scheduling Service from Revint Solutions

What You Should Know: – T2 Tech Group, a Los-Angeles based leading IT consulting, advisory, and project management services provider, has just acquired the patient access and scheduling services division from Revint Solutions. – The coronavirus pandemic has created a vast backlog of patient appointments and compounded the strain on the healthcare industry. This acquisition …

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DAS Health Acquires Managed IT Services and CyberSecurity Company Technology Seed

– Both companies’ clients will gain an increased depth of IT and security support, and Technology Seed’s healthcare clients will now have a substantially improved value proposition DAS Health Ventures, Inc., a provider of health IT and management, announced today it completed the acquisition of Technology Seed, LLC, a managed IT and cybersecurity services company based in Salem, NH. …

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Sharecare Acquires WhiteHatAI to Enhance Healthcare Payment Integrity

What You Should Know: – Sharecare acquires WhiteHatAI to provide health plan and provider clients with additional capabilities to ensure healthcare payment integrity  – WhiteHatAI’s ability to detect erroneous claims before they are paid will help Sharecare’s health plan partners reduce costs associated with FWA. – Sharecare will integrate WhiteHatAI’s capabilities to foster deeper engagement …

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HealthEdge Software Acquires Payment Integrity Solution The Burgess Group

What You Should Know: – HealthEdge Software announces the acquisition of The Burgess Group, LLC (“Burgess”), an innovative payment integrity software company focused on improving healthcare payment operations for an undisclosed sum. – The strategic acquisition will boost Health Edge’s position in the payment integrity market and extends best-in-class claims processing to include software-driven payment …

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BJC HealthCare Taps Patientco to Provide Seamless Patient Payment Experience

What You Should Know: – BJC HealthCare has signed an agreement with patient payment platform Patientco to offer a seamless patient financial experience, helping patients navigate their medical expenses and pay their bills. – Patientco’s platform provides patients with a single billing statement outlining their outstanding balance and will help BJC streamline its payment process by reducing the number of bills associated with one visit as well as …

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COVID-19: 4 Essential Patient Payment Strategy Components to Accelerate Cash Flow

David Shelton, PatientMatters CEO In the past few months, the COVID-19 pandemic has shaken societies, economies, and human wellbeing to the core. While protecting public health and welfare are top priorities for hospitals, the harsh reality is that it takes cash to keep the doors open and serve patients effectively. Revenue is down significantly as …

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Banner Health to Implement Cerner Revenue Cycle Management Across Enterprise

What You Should Know: – Cerner and long-time client Banner Health announced a new deal to implement a comprehensive suite of revenue cycle management solutions as part of a long-standing strategic alignment to use health care technology to drive population health improvement. – The revenue cycle integration will take place across Banner Health’s entire system, including …

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4 Ways Healthcare Organizations Can Establish Partnerships to Drive Innovation

With public and private healthcare spending significantly outpacing that of other countries, U.S. hospitals face intense pressure to find new ways to capture greater value. More and more, organizations are finding that partnerships with existing vendors can help unlock next-level performance gains in a transformative environment. Take Nebraska Medicine, for example. In the early 2000s, …

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