Sign up for our daily briefing

Make your busy days simpler with Axios AM/PM. Catch up on what's new and why it matters in just 5 minutes.

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Catch up on the day's biggest business stories

Subscribe to Axios Closer for insights into the day’s business news and trends and why they matter

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Stay on top of the latest market trends

Subscribe to Axios Markets for the latest market trends and economic insights. Sign up for free.

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Sports news worthy of your time

Binge on the stats and stories that drive the sports world with Axios Sports. Sign up for free.

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Tech news worthy of your time

Get our smart take on technology from the Valley and D.C. with Axios Login. Sign up for free.

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Get the inside stories

Get an insider's guide to the new White House with Axios Sneak Peek. Sign up for free.

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Catch up on coronavirus stories and special reports, curated by Mike Allen everyday

Catch up on coronavirus stories and special reports, curated by Mike Allen everyday

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Want a daily digest of the top Denver news?

Get a daily digest of the most important stories affecting your hometown with Axios Denver

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Want a daily digest of the top Des Moines news?

Get a daily digest of the most important stories affecting your hometown with Axios Des Moines

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Want a daily digest of the top Twin Cities news?

Get a daily digest of the most important stories affecting your hometown with Axios Twin Cities

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Want a daily digest of the top Tampa Bay news?

Get a daily digest of the most important stories affecting your hometown with Axios Tampa Bay

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Want a daily digest of the top Charlotte news?

Get a daily digest of the most important stories affecting your hometown with Axios Charlotte

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Want a daily digest of the top Nashville news?

Get a daily digest of the most important stories affecting your hometown with the Axios Nashville newsletter.

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Want a daily digest of the top Columbus news?

Get a daily digest of the most important stories affecting your hometown with the Axios Columbus newsletter.

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Want a daily digest of the top Dallas news?

Get a daily digest of the most important stories affecting your hometown with the Axios Dallas newsletter.

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Sign up for Axios NW Arkansas

Stay up-to-date on the most important and interesting stories affecting NW Arkansas, authored by local reporters

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Illustration: Annelise Capossela/Axios

Money is flowing heavily into the business of medical billing as hospitals and doctors — whose revenues were disrupted by the coronavirus — focus on maximizing every dollar they can collect from patients and insurers.

The big picture: The rise and even existence of the billing industry is the result of a fragmented system that is designed around multiple types of insurance plans and a system that has increasingly forced patients to shoulder more of the costs of their care.

The state of play: Companies involved with billing and collections, called "revenue cycle management" in industry jargon, increasingly advertise themselves to health care providers as one-stop shops for all things involving payments.

  • They verify patients' insurance, help hospitals update their pricing lists, code the medical claims that are sent to insurers and government programs, fight with insurers over denials, and collect payments from patients before and after they get care.

Driving the news: The pandemic drastically shrank revenue among hospitals and other providers, and although that drop was relatively short-lived, it spurred even more revenue cycle activity.

  • Ensemble Health Partners filed to go public last week. The company pitched investors by saying, "Coding standards are constantly evolving ... it is often difficult for providers to adapt to these changes on a timely basis."
  • UnitedHealth Group is attempting to buy Change Healthcare for $8 billion, although the Federal Trade Commission has asked for more information.
  • The publicly traded R1 RCM has spent $800 million since 2018 to buy three separate revenue cycle firms. R1 changed its name in 2017, from Accretive Health, after the company settled allegations that it hounded patients for payment in emergency rooms.
  • Private equity firms have always had interest in revenue cycle, and own large stakes in Ensemble and R1. Welsh, Carson, Anderson & Stowe recently acquired Argos Health, and four different companies merged to form CorroHealth, which is backed by the Carlyle Group.
  • There are so many other revenue cycle deals within the past year.

Between the lines: Lawsuits against patients over medical bills aren't the only controversial industry tactic. Submitting bills for more expensive services than were actually provided, a practice called upcoding, have generated bigger concerns.

  • One hospital executive told David Seltz, the head of Massachusetts' health policy agency, that his system has hired more people to work exclusively on coding.
  • "The more [people] you hired, the more revenue you could generate," Seltz said, according to Modern Healthcare. "His analysis was that there was no peak."

One step deeper: Hospitals aren't just clients of revenue cycle firms. They also are investors in some cases.

  • R1 is part-owned by hospital systems Ascension and Intermountain, and Ensemble is part-owned by Catholic hospital system Bon Secours Mercy Health. Those tax-exempt systems serve as both owners and major clients, which means they benefit twice from any payments that are collected.
  • Tenet Healthcare recently sold five of its hospitals, and stipulated those hospitals had to continue using Tenet's revenue cycle firm, Conifer Health Solutions. HCA Healthcare also owns one of the country's largest billing firms, Parallon.

The bottom line: The revenue cycle frenzy is a result of "providers trying to win as much revenue as possible," said Ge Bai, a health policy and accounting professor at Johns Hopkins. But that's also meant "patients are more and more being treated as a revenue-generating product."

Go deeper

Oct 15, 2021 - Health

Maine health care staff won't get unemployment benefits if they refuse vaccine

A pharmacy technicinan specialist at Maine Medical Center in South Portland, Maine. Photo: Derek Davis/Portland Press Herald via Getty Images

Maine health care workers who face firing for defying COVID vaccine requirements will not be eligible to receive unemployment benefits, AP reports.

Why it matters: The notice comes as Maine's hospitals suffer labor shortages partly related to the state's vaccine mandate. One of the state's biggest hospitals has had to turn away trauma and pediatric patients and shutter an entire department, according to a local CBS affiliate.

10 mins ago - Technology

Race and technology in America

Illustration: Annelise Capossela/Axios

The technology industry is famously determined to change the world — but its efforts to diversify its workforce and remove bias from its products haven't changed nearly enough.

Biden: "Being a cop today is one hell of a lot harder than it's ever been"

President Biden speaks during the 40th Annual National Peace Officers Memorial Service at the U.S Capitolon Oct. 16. Photo: Brendan Smialowski/AFP via Getty Images

President Biden speaking at the U.S. Capitol on Saturday honored members of law enforcement who died in the line of duty in 2019 and 2021 and saluted those who are currently serving.

Driving the news: "We expect everything of you, and it's beyond the capacity of anyone to meet the total expectations. Being a cop today is one hell of a lot harder than it's ever been," Biden said.

You’ve caught up. Now what?

Sign up for Mike Allen’s daily Axios AM and PM newsletters to get smarter, faster on the news that matters.

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!