Revenue Cycle and Payer News – January 29, 2025
Reported payers and health insurance industry news from Humana, Aetna, Anthem Blue Cross and Blue Shield, UnitedHealth Group, Banner|Aetna, CVS Health, Cigna, and more.
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How a Duty To Spend Wisely on Worker Benefits Could Loosen PBMs’ Grip on Drug Prices
By Arthur Allen – In recent years, the opaque business practices of PBMs have drawn fire. The Federal Trade Commission is conducting a lengthy investigation of the three biggest companies and sued them in September, accusing the firms of driving up insulin prices.
Ensuring Your Service Line Profitability Report Gets the Attention it Deserves
By Christie Scanlon – A carefully crafted Service Line Profitability report can be like a New Year’s resolution: Packed with potential, ready to reveal operational efficiencies, uncover opportunities, and provide strategic recommendations. But if not presented the right way, there is a real risk the most insightful of reports and dashboards will be ignored.
Overcoming Healthcare’s Skills Gap in Revenue Cycle Management
By Chris Klitgaard – Roughly 4.1M Americans will turn 65 every year through 2027. The largest number reaching retirement ever, and Boomers are leading the way. The “silver tsunami” arrives along side of the healthcare industry losing 2M workers by 2029.
The Cost of Healthcare
By Jay Eisenstock – The shocking execution of the CEO of America’s largest health insurer has reignited widespread criticism of the health insurance industry, often viewed as primarily responsible for the high cost of healthcare. While these companies bear some responsibility, the issue is far more complex with blame shared across the entire system.
Medical Billing Challenges: How Healthcare AI Helps Navigate Claim Denials
By John T. Bright – Medical billing inaccuracies remain a significant issue in the U.S. healthcare system, contributing to inefficiencies that negatively impact providers and patients. These errors not only affect the revenue cycle but also hinder operational productivity and reduce patient satisfaction.
How the Right Financial Strategy Can Stop the Erosion of Rural Hospitals
By Pete Heydt – When half of rural hospitals are operating in the red and 418 are vulnerable to closure, the data alone are a call to action for new approaches to capturing revenue. Turning up the focus on patient financial engagement in ways that meet consumers where they are is one essential step.
Revenue Cycle and Payer News – December 4, 2024
Reported payers and health insurance industry news from Humana, Independence Blue Cross, Anthem Blue Cross and Blue Shield, CareSource, Cigna, Oscar Health, AHIP and more.
Using AI to Enhance Payment Integrity
By Matthew Hawley – Artificial intelligence has been touted as a “solution” to modernize many payers’ processes and functions, including their traditional payment integrity programs. Yet seeing AI as the answer to health plans’ administrative burdens is overly simplistic.