Business Intelligence

Providers utilize business intelligence to monitor referral patterns and collaborate with clinicians who order their services. Such analytics tools have also been deployed in the specialty to improve productivity, track patient satisfaction and bolster quality.

Florida probes CVS Health in latest crackdown on PBMs
State Attorney General James Uthmeier is forcing the company to hand over thousands of documents related to its pharmacy contracts and reimbursement policies to see if the retail giant is abusing its position in the market as both a pharmacy benefit manager and a retail chain of drug stores.
Private equity unlikely to dominate cardiology despite hype
Medaxiom CEO Jerry Blackwell, MD, MBA, FACC, discusses investor's interest in buying cardiology practices, noting that PE ownership remains relatively low.
OIG warns of ‘ghost network’ trouble in maternal health managed care
Looking at the three largest Medicaid managed care plans related to maternal health, the Office of Inspector General found instances of ineligible providers being included in directories, as well as other errors such as incorrect contact information.
OhioHealth agrees to void contracts that allegedly punished payers for including competitors in-network
The U.S. Department of Justice said the settlement will save citizens of the state money and open up the market to competition.
Major private payer encouraging employees to leave willingly
The largest Medicaid-specialized managed care organization in the U.S. is offering buyout packages to most of its 60,000 or so staff workers.

hospitals accounts receivable unpaid claims

Denied claims increasingly saddle hospitals with cashflow lags

Over the past three years, the value of claims waiting longer than 90 days for payment from commercial payers has risen by 33%. Stalled Medicare Advantage claims have spiked by even more.

Credit forecast: Hospitals will recover only slowly from lingering ‘labor-demic’

In its annual outlook report released this week, Fitch Ratings says the coming calendar year will probably strike much of the sector as “another make or break” period.