The Hidden Cost of Write-Off Culture in Hospital Revenue Cycles
Rising claim denials & staffing shortages are driving hospitals to write off recoverable revenue.
Setting Revenue Cycle Goals for 2026: Why Denied Claims Deserve a Second Look
As hospitals begin setting financial goals for 2026, Revenue Cycle Management (RCM) leaders face familiar challenges: rising denial rates, ongoing staffing constraints, payer complexity, and constant pressure to improve
AI Fatigue in RCM: When the Buzz Starts to Blur the Value
If you’ve read a healthcare revenue cycle management article in the past year, chances are it mentioned AI… often repeatedly. Artificial intelligence has become the centerpiece of nearly every headline, product launch, c
Closing Out 2025 Strong: Why Hospitals Can’t Afford to Leave Denied Claims Unrecovered
As hospitals work to strengthen their financial performance heading into the final quarter of 2025, denied claims remain one of the biggest and most underestimated drivers of lost revenue. Nationwide, claim denial rates
The Modern Maze: What’s Challenging Hospital Revenue Cycle Managers in 2025?
The current healthcare environment is extremely unpredictable, and revenue cycle managers (RCMs) at hospitals are facing more pressure and complexity than ever before. From technology transformation and AI adoption to…
The Crucial Role of AI and Human Expertise in Resolving Denied Claims for Hospitals
In today’s rapidly evolving healthcare landscape, the intersection of artificial intelligence (AI) and human expertise is revolutionizing the way hospitals navigate denied insurance claims. While AI and technology have s
Battling Denied Claims: The Uphill Struggle Facing Dialysis Centers
Dialysis centers across the United States often face significant challenges when it comes to denied insurance claims, which can have profound implications for both patient care and their financial stability.…
ERISA Recovery Saves University Hospitals Millions
Dallas, Texas—August 24, 2023: The CEO of a Dallas healthcare fintech company today announced helping two medical systems affiliated with universities recover millions of dollars in unpaid health insurance claims.…
ERISA Recovery Uses Technology To Win Back Time & Money For Cancer Centers
Without fail, the best cancer centers are focused on helping and healing. This involves ensuring their oncology patients can access lifesaving treatment(s). In order for cancer centers to provide this…
Clinical Claims Denials Challenge Healthcare Systems’ Budgets
Despite their responsibility to patients and medical providers, insurance companies often use clinical claims denials to justify rejecting claims. A clinical denial is when an insurance company refuses to pay…
Cancer Centers Face Increasing Claim Denials: ERISA Recovery Can Help
Today’s healthcare revenue landscape presents many unique challenges for medical centers. Overall, many hospitals and practices have seen expenses increase while reimbursements decline. Costly write-offs can result when
US Healthcare System Strained by Rising Claim Denial Rates
Rising claim denial rates is one of the most critical revenue cycle issues the US healthcare system is currently facing. The latest data from KaufmanHall suggests that 2022 was the worst fiscal…
Medical staff costs unsustainable, warns AHA
Labor costs and low morale are looming emergencies for medical systems revenue cycle directors in 2022. Doctors and nurses are suffering burnout and quitting or reducing hours. These medical staff…
ERISA Recovery: EMR and EHR Conversion Specialists
One of the most daunting challenges medical practices face is when they change systems for managing patients’ data during an electronic medical record (EMR) conversion. If the EMR conversion is…
What is the ERISA appeals process, and why is it important?
Insurance companies conduct business based on the premise that their policies are the last word on whether they pay or deny a healthcare claim. This assumption, however, is false. The…
Hospital Claims Recovery More Important Than Ever for 2021
Delta variant destabilizes healthcare planning: With the spread of the more contagious delta variant, Covid-19 cases spiked almost 70 percent in the last week (www.washingtonpost.com/…covid-cases-rising/). The public hea
COVID-19’s Rising Number Of Patients Does Not Equal More Money
While the COVID-19 pandemic flooded hospitals with patients in 2020, healthcare systems did not benefit financially. In most businesses, more customers mean more money. In the case of hospitals, those…
Hospitals May Be Expected to Cover Costs of COVID-19 Vaccines
2021 is here and with a new year, there’s word of COVID-19 vaccines making their way throughout the United States. While rollout is slower than expected, about 5 million people…
Medicaid Expansion And What It Means For The States That Opted For It
Medicaid expansion has affected hospitals’ finances. This is according to research found in a study conducted by the Urban Institute. The data used was collected from the American Hospital Association…
Resource Constraints Prevent Healthcare CFOs From Reducing Costs
Reducing costs is important in any industry, but especially in the healthcare field. While reducing costs is currently a top priority for healthcare CFOS, the lack of sufficient data and…
32 Hospitals Have Filed for Bankruptcy This Year – Here’s How to Prevent Yours From Being Next
Recently, additional hospital bankruptcies have hit the news. With the pandemic still raging on and emergency rooms and wards becoming overcrowded, you’d think that hospitals would have a steady flow…
Tips for Avoiding Payment Denials – And What to Do When One Occurs
Payment denials, especially those issued by commercial health insurance companies, can add up over time. They not only cost you money, due to the person-power required to collect on those…
Important Changes in Hospital Culture as a Result of COVID-19
As the COVID-19 pandemic continues, hospitals have begun to make some changes. We’ve discussed how many have made plans to expand, closed their doors, or laid off staff, depending on…
Hospital Closures Paint a Grim Picture of the Healthcare Industry in the Wake of Covid-19
Since the beginning of the year and the start of the Covid-19 pandemic, 18 hospitals in the United States have closed. This illustrates just how much the health care industry…
Covid-19 Updates and What Your Healthcare Institution Can Do
As the Covid-19 pandemic rages on with no signs of stopping or slowing down, some healthcare experts feel powerless. Their emergency rooms are filling up with patients, employees are scheduling…
Some Good News About Hospital Financials Coming Out of the Covid-19 Pandemic
Not every hospital system has fallen victim to the financing issues that came along with the Covid-19 pandemic. Some have managed to pull themselves up and managed to land in…
Reassessing Outpatient Surgical Centers After Covid-19
The Covid-19 pandemic changed plenty of things about medical care, including how ambulatory surgical centers will operate in the future. Experts have made a number of predictions based on observations…
Dire Post-COVID-19 Predictions for the Healthcare Industry
As if that state of the industry weren’t dire enough, now experts are predicting that as a result of COVID-19 and all of the routine exams, checkups, and voluntary surgeries…
Hospitals in Rural Areas May Still Close Despite Pandemic
One would think that hospitals would have increased numbers of patients during a pandemic. After all, aren’t their services needed? This actually isn’t the case for some hospitals in rural…
CMS and COVID-19: A Timeline
COVID-19 has been in the news since at least December, giving the Centers for Medicare & Medicaid Services, or CMS, plenty of time to prepare. They’ve taken a number of…
Hospitals Begin Placing Non-Essential Staff Members on Furloughs
In response to the COVID-19 pandemic, many hospitals are trimming costs and reducing potential exposure by placing non-essential staff members on furloughs. Only time will tell whether or not this…
Five Important Hospital Trends for 2020
Every year, experts in the field make predictions about the health care industry. This year, there are five important things that might happen. According to Rick Pollack, president and CEO…
Attempts to Change Out-of-Network Rates May Lead to Even More Claim Confusion
Currently, out of network claims are much higher than standard in-network ones. There are plenty of reasons for this, but what matters is that lawmakers are trying to simplify the…
Chargemaster Rates and Claim Denials -What You Need to Know
Hospital billing systems are complicated. There’s a reason why billing employees go through plenty of training. Between the various doctor fees, medication costs, room charges, and procedure costs, there’s a…
Surgical Center Growth Can Lead to Issues When There Are Unpaid Claims Involved
Throughout 2019, a new trend emerged in healthcare – surgical centers. Although these centers, which are designed solely for outpatient surgeries, have been around for many years, quite a few…
Out of Network Billing Can Lead to Federal ERISA Appeals
Anyone who’s read the paperwork that comes with their health insurance policy is no doubt aware of the differences between in-network and out of network appointments and procedures. These procedures…
Using AI Modeling to Prevent Claim Denials
Modern technology has made it possible for health care officials to use things like predictive analytics in order to improve collection times. For the most part, this technology has been…
Using Federal ERISA Appeals to Save Rural Hospitals in Tennessee and Throughout the United States
According to a recent segment on ABC News, yet another hospital in Tennessee is closing its doors. The main issue with this is that it’s the only one around for…
Staffing Cuts Can Be Avoided Thanks to the Federal ERISA Appeals Process
Many healthcare companies, ranging from the large (hospitals) to the small (general clinics) and everything in between, are trying to cut costs due to financial pressures. As a result, this…
Hospital Closures Can Be Prevented with ERISA Appeals
More hospital closures are on the horizon. The most recent of them, St. Mary Hospital in Port Arthur, Texas, is just one of the many that have shut their door…
Payer Contracts and Federal ERISA Appeals: Using One to Avoid the Other
Recently, an article came out explaining how hospitals and health clinics can improve their payer contracts. These contracts, which exist between the healthcare provider and the commercial health insurance company,…
Are Automated Systems the Best Option for Hospital Billing?
Hospitals have begun experimenting with the use of automated systems when it comes to managing their billing. Although a recent article hasn’t made it clear how extensive this practice is…
Ambulatory Surgical Center Growth and Unpaid Commercial Health Insurance Claims
According to recent headlines, Surgical Care Affiliates, which is based in Deerfield, Illinois, is going to be adding at least 20 more Ambulatory Surgical Centers, or ASCs, to their portfolio…
Good News For Some In The Healthcare Industry As Systems Expand
Not all of the news has been bad lately, as far as hospitals are concerned. Recent headlines have included updates from five different medical centers around the United States that…
Federal ERISA Appeals Can Help Save Your Hospital
It’s happened again. Another hospital is on the brink of financial disaster. However, this one, instead of closing its doors entirely, is planning on cutting services and jobs. The administrators…
More Hospitals Struggle With Unpaid Commercial Health Insurance Claims – But We Have a Solution
Another week and there are more hospitals with financial struggles in the news. This seems to be an increasing trend, as more and more health care centers face financial problems…
Hospital Closures Can Be Prevented Thanks to the Federal ERISA Appeals Process
It seems as though hospital closures pop up in the news constantly. Every week at least one of them files the paperwork necessary to go out of business due to…
How Technological Advances Can Help You Refine Your Hospital’s Billing Practices
Many hospitals still use old-fashioned billing systems. While these systems eliminate the need to train your employees on how to use them, they pose a problem for hospitals and clinics…
The Rise In Surgical Centers Is Only Matched By The Number Of Unpaid Claims That They Are Faced With
The statistics don’t lie – surgical centers are becoming incredibly popular. These clinics tend to focus on one type of healthcare only: outpatient surgeries. While this is good for patients…