Insights and Innovations in Revenue Cycle Management
Court Ruling Strengthens Provider Rights: Enforcing IDR Awards Under the No Surprises Act
A recent federal court decision is making waves in the healthcare reimbursement landscape—especially for emergency medicine providers and freestanding ERs. In a pivotal case, a court has recognized a private right of action for providers to enforce Independent Dispute...
The Impact of Forced Consolidation of Emergency Medicine Groups
The emergency medicine landscape is undergoing rapid transformation, and one of the most significant shifts in recent years is the forced consolidation of independent emergency medicine groups (EM). As pressures from policy changes, reimbursement cuts, and health...
Emergency Medicine Feels the Impact: 39% Reduction in Out-of-Network Reimbursement Since No Surprises Act
A recent survey by the Emergency Department Practice Management Association (EDPMA) has confirmed what many emergency medicine groups have already experienced firsthand: a significant drop in out-of-network reimbursement since the No Surprises Act (NSA) took effect....
Understanding the Payment Landscape: What RAND’s Latest Hospital Price Transparency Study Means for Emergency Medicine Providers
The RAND Corporation recently released its latest hospital price transparency study, analyzing the rates that private insurers pay hospitals and ambulatory surgical centers (ASCs) across the United States. The findings, based on claims data from 2022, continue to shed...
April 2025 Policy Update: What Emergency Medicine Providers Should Know
Staying informed about federal policy changes is crucial for emergency departments and freestanding ERs navigating complex reimbursement and operational challenges. The latest “Health on the Hill” briefing from April 9, 2025, highlights several developments that could...
Three Years Later: What Providers Have Learned from the No Surprises Act
It’s been three years since the No Surprises Act (NSA) took effect, reshaping how providers, payers, and patients navigate out-of-network billing and reimbursement. While the goal of protecting patients from unexpected medical bills is widely supported, the ongoing...
The Growing Frustration with Payers: How Claim Denials Impact Healthcare Providers
Claim denials continue to be a major source of frustration for healthcare providers, leading to financial strain, administrative burden, and delays in patient care. Despite efforts to streamline reimbursement processes and improve payer-provider relationships,...
The Future of RCM: Navigating the Surge in Outsourced Revenue Cycle Solutions
The revenue cycle management (RCM) industry is rapidly evolving, with market projections estimating that the RCM vendor market could reach nearly $1 trillion globally within the next decade. According to a recent report by HealthLeaders, the increasing complexity of...
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