Topics
Reimbursement
Behavioral health should shift to value-based care despite challenges, Evernorth says
Evernorth: Behavioral health should shift to value-based care
Revenue Cycle Management
Modernizing healthcare payment systems starts with reducing cash collections
Modernizing healthcare payment systems starts with reducing cash collections
Strategic Planning
Advocate Health closing Illinois clinics inside of Walgreens
Advocate Health closing Illinois clinics inside of Walgreens
Capital Finance
HIMSS25: ROI as the ultimate measure of value
HIMSS25: ROI as the ultimate measure of value
Supply Chain
Hospitals face rising costs, supply chain disruptions as tariff uncertainty continues
Hospitals face rising costs as tariff uncertainty continues
Accounting & Financial Management
Ambulatory surgery centers drive Tenet's strong Q4 results
Ambulatory surgery centers drive Tenet's strong Q4 results
Budgeting
Health system operating margins declined in August
Health system operating margins declined in August
Quality and Safety
Senate report slams private equity's ownership of hospitals
Senate report slams private equity's ownership of hospitals
Billing and Collections
Revenue cycle challenged by low collection rates, high denials
Revenue cycle challenged by low collection rates, high denials
Claims Processing
Sen. Grassley wants UnitedHealth to hand over MA billing records
Sen. Grassley wants UnitedHealth to hand over MA billing records
Workforce
Cedars-Sinai cancer director stepping down
Cedars-Sinai cancer director stepping down
Operations
Chief growth officer on the competitiveness of home health market
Chief growth officer on the competitiveness of home health market
Medical Devices
Logistics robots bringing Samsung Medical Center into the future
Logistics robots bringing Samsung Medical into the future
Hospital/physician relations
Hospitals, physicians submit opposing views to FTC ruling on noncompetes
Hospitals, physicians submit opposing views to FTC ruling
Construction & Facilities Management
Prisma Health opens $3.7 million behavioral health facility
Prisma Health opens $3.7 million behavioral health facility
Compliance & Legal
Hospitals face deadline to opt out of BCBS settlement agreement
Hospitals face deadline to opt out of BCBS settlement agreement
Policy and Legislation
HIMSS25: What's happening nationally and globally with telehealth, AI and cybersecurity
HIMSS25: What's happening nationally and globally with telehealth, AI and cybersecurity
Community Benefit
Mobile Healthcare does house calls
Mobile Healthcare does house calls
Accountable Care
HIMSS25 session shows how physicians are incentivized in alternative payment models
HIMSS25 session shows how physicians are incentivized in APMs
Acute Care
SDOH, tech key to advancing value-based care, says UHG
SDOH, tech key to advancing value-based care
Ambulatory Care
Fewer clinicians entering primary care, data shows
Fewer clinicians entering primary care
Analytics
Kentucky making data on foster children interoperable
Kentucky making data on foster children interoperable
Business Intelligence
Research funding cuts put healthcare in a 'shaky period,' says HIMSS CEO
Research funding cuts put healthcare in a 'shaky period,' says HIMSS CEO
ICD-10 & Coding
Physician practices examine risk adjustment coding in wake of federal lawsuits
Practices keeping close watch on risk adjustment coding
Meaningful Use
Financial disincentives for providers who commit information blocking 
Financial disincentives for providers who commit information blocking 
Medicare & Medicaid
AMA among organizations asking RFK Jr. to reschedule immunization meeting
AMA among organizations asking RFK Jr. to reschedule immunization meeting
Patient Engagement
HHS, Illinois reach agreement on disability rights laws
HHS, Illinois reach agreement on disability rights
Pharmacy
PBMs appeal FTC case over insulin costs 
PBMs appeal FTC case over insulin costs 
Population Health
Obesity rates driving up healthcare costs, report finds
Obesity rates driving up healthcare costs
Risk Management
UPMC for You partners to offer Medicaid redetermination coverage in laundromats
UPMC for You offers Medicaid redetermination coverage in laundromats
Telehealth
Philips partners for maternal remote patient monitoring in Georgia
Philips partners for maternal remote patient monitoring in Georgia
Mergers & Acquisitions
Yale New Haven calls Prospect deal 'impossible'
Yale New Haven calls Prospect deal 'impossible'
View more

Claims Processing

Claims Processing

In-depth

Healthcare.gov plans denied 20% of claims in 2023

Healthcare.gov plans denied 20% of claims in 2023

Reasons include prior authorization or referral, excluded services and administrative issues, KFF finds.

Sen. Grassley wants UnitedHealth to hand over MA billing records

Sen. Grassley wants UnitedHealth to hand over MA billing records

Letter to CEO Andrew Witty follows report of DOJ launching investigation into the company's…

Whitepapers

Healthcare lease accounting insights: How two organizations got compliant and stay audit-ready all year long

Healthcare lease accounting insights: How two organizations got compliant and stay audit-ready all year long

Healthcare organizations (HCOs) often hold multiple…

The Changing Role of The Healthcare Finance Leader

The Changing Role of The Healthcare Finance Leader

Gone are the days when the healthcare finance leader simply reported on the results of the previous month,…

Latest News

February 26, 2025 | Susan Morse

Sen. Grassley wants UnitedHealth to hand over MA billing records

February 14, 2025 | Jeff Lagasse

Class action lawsuit against UnitedHealth's AI claim denials advances

February 4, 2025 | Jeff Lagasse

Cigna to accelerate prior authorization and tie executive pay to member satisfaction

February 3, 2025 | Jeff Lagasse

Healthcare.gov plans denied 20% of claims in 2023

January 28, 2025 | Jeff Lagasse

190 million people affected by Change Healthcare cyberattack

January 6, 2025 | Susan Morse

Mayo Clinic sues Sanford Health Plan over unpaid medical bill

December 30, 2024 | Nathan Eddy

Athenahealth leverages AI to power RCM offering

VIEW ALL NEWS

MostPopular

Senate strikes down healthcare worker vaccine mandate

Senate strikes down healthcare worker vaccine mandate

CDC relaxes indoor mask guidance, including for schools

CDC relaxes indoor mask guidance, including for schools

CA lawmakers introduce bill mandating workplace vaccinations

CA lawmakers introduce bill mandating workplace vaccinations

CVS files patent to sell healthcare services in the metaverse

CVS files patent to sell healthcare services in the metaverse

Optum: UnitedHealth's secret weapon

Optum: UnitedHealth's secret weapon

Biggest trends are hospital care at home and widening labor gap

Biggest trends are hospital care at home and widening labor gap

Anthem to rebrand as Elevance Health

Anthem to rebrand as Elevance Health

News

Ending racism in healthcare often begins with medical education - and is the target of a new national project

Ending racism in healthcare often begins with medical education - and is the target of a new national project

Inequities can be found in every facet of the industry, but targeting medical students and residents can help stem the tide.

Healthcare organizations ask HHS to delay quality measure reporting for ACOs

Healthcare organizations ask HHS to delay quality measure reporting for ACOs

The American Hospital Association and American Medical Association are among the 11 organizations signing the letter.

Whitepapers

Credible, Defensible Estimates

Credible, Defensible Estimates

In healthcare, every interaction with the patient matters. Especially in today's environment of continuous improvement, efforts have been concentrated on coordination among providers, the patient care experience and quality outcomes - all laudable goals.

Gaining Actionable Insight into Financial Systems and Areas Impacting the Revenue Cycle

Gaining Actionable Insight into Financial Systems and Areas Impacting the Revenue Cycle

Hospital systems across the country are looking to streamline their billing and collection processes to become more efficient and better compete in their markets. The challenge many face is how to turn the data that's already flowing through financial systems into…

Clinical Quality Measures 101

Clinical Quality Measures 101

Although quality-reporting programs such as meaningful use provide incentives to help providers implement and use electronic health records (EHRs) to collect and report on clinical data, practices often need help deciding what data to collect, which measures to…