Tag: Managed Care
2023 revenue challenges: Turning the tide in 2024
In 2023, hospitals and health systems faced financial pressures from Medicaid redeterminations, Medicare Advantage's rapid growth, and shifting expectations of commercially insured patients, requiring proactive strategies in reimbursement, contract negotiations,...
Denials by bots: Why providers need to keep an (even closer) eye on claims
Payers increasingly rely on AI and automation to process claims, leading to higher denial rates, lawsuits, and scrutiny, necessitating proactive provider strategies to challenge harmful practices and safeguard revenue.
Shifts in healthcare, provider hurdles, & the flywheel effect
UnitedHealth Group's vertically integrated model leverages its assets to drive profitability while straining providers through low reimbursement rates, fueling industry-wide tension and highlighting the need for proactive strategies to address...