payers
publication date
CFO
The Crucial MA Crossroads, and How CFOs Are Taking the Wheel
As CMS reins in Medicare Advantage payments and provider tensions rise, CFOs are rethinking MA strategy, risk exposure, and long-term...
Revenue Cycle
HL Shorts: 3 Tips to Prevent Denials in Contract Negotiations
Mercyhealth Vice President of Managed Care Bradley Olson shares the strategies he uses in contract negotiations to keep payers accountable....
Revenue Cycle
The Winning Edge on Defeating Denials
During this installment of HealthLeaders' The Winning Edge series, revenue cycle leaders from Mercyhealth and Wellstar Health System share how...
Revenue Cycle
Infographic: 3 Takeaways From the Winning Edge on Defeating Denials
As payers deploy AI to automate claim reviews, revenue cycle leaders share the strategies they are adopting to fight back....
Revenue Cycle
The Winning Edge Recap: Rethinking Denial Management Strategies to Counter Payer AI
As payers deploy advanced tech to scrutinize claims, health systems like Mercyhealth and WellStar are fighting back with stricter contracts...
Revenue Cycle
CMS Signals MA Payment Slowdown as Provider Frustration With The Plans Continue to Mount
The proposal reinforces concerns that MA incentives remain misaligned with clinical reality.
CFO
Sick of Fighting Insurers, Hospitals Offer Their Own Medicare Advantage Plans
While the number of Advantage plans owned by hospital systems is relatively stable, Mass General Brigham in Boston and others...
Revenue Cycle
The Winning Edge: Strategies for Defeating Denials at the Source
Spending hit $5.3 trillion in 2024, but the shift to marketplace plans and a sicker Medicaid pool means more dollars...
Revenue Cycle
Anthem Alleges Fraud in IDR Process
Anthem Blue Cross accuses the Prime Healthcare entities chain of using false attestations to flood the IDR system with ineligible...
CFO
Infographic: 3 Finance-Business Lessons From Veteran CEO Mike Maron
Lessons from CEO Mike Maron on strategic finance, culture-driven resilience, and investments that support long-term sustainability.
Revenue Cycle
Infographic: 4 Rev Cycle Takeaways from 2024 Healthcare Spending Data
Spending hit $5.3 trillion in 2024. Shifts to Marketplace plans along with a more costly Medicaid pool will require revenue...
Revenue Cycle
4 Rev Cycle Takeaways from 2024 Healthcare Spending Data
Spending hit $5.3 trillion in 2024, but the shift to marketplace plans and a sicker Medicaid pool means more dollars...