New & Notable
Deep RCM vendor partnership drives better collections, efficiency
New KLAS report reveals providers using at least three RCM modules from one vendor gain workflow efficiencies and better cash flow, but integration challenges persist for some.
Pharma loses appeal to change 340B drug discounts to rebates
Major drugmakers lost their bid to impose rebate models on 340B providers, as a court ruling states that only the HHS can authorize changes to the drug discount program structure.
Why providers can't get paid for using clinical AI tools
Healthcare payment models aren't built for AI, say industry leaders in a new report, which proposes a reimbursement framework as CMS launches a model to pay for technology-enabled care.
Doc pay, price transparency on Congress’ healthcare agenda
Lawmakers introduced or advanced a raft of health legislation this week in advance of the midterm elections.
— Healthcare DiveSponsored Sites
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Specialty Drug Management
Optum Specialty Fusion
At Optum, we’re evolving health care so everyone can have the opportunity to live their healthiest life. It’s why we put your unique needs at the heart of everything we do, making it easy and affordable to manage health and well-being. Together, for better health.
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Risk Adjustment Compliance
RAAPID
RAAPID develops AI-powered risk adjustment solutions for healthcare payers, providers, and supporting organizations. The company's HITRUST-certified platform uses Neuro-Symbolic AI to identify chronic conditions, determine HCC codes, and provide explainable documentation for complete audit defense. Backed by M12 (Microsoft's venture fund), RAAPID serves organizations participating in Medicare Advantage, ACA, Medicare ACO, and Medicaid programs with both retrospective and prospective risk capture capabilities. Founded by healthcare technology veterans with over 20 years of experience, RAAPID is headquartered in Louisville, Kentucky.
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Revenue Cycle Management
Greenway Health
Improving healthcare through innovation is at the heart of Greenway Health’s work. We provide electronic health records (EHR), practice management, and revenue cycle management solutions that help practices in multiple specialties grow profitably, remain compliant, work more efficiently, and improve patient outcomes.
Healthcare Strategies: A Podcast
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A podcast for healthcare professionals seeking solutions to today's and tomorrow's top challenges. Hosted by the editors of Xtelligent Healthcare Media, this podcast series focuses on real-world use cases that are leading to tangible improvements in care quality, outcomes, and cost.
Guests from leading provider, payer, government, and other organizations share their approaches to transforming healthcare in a meaningful and lasting way.
View All Episodes
Latest News
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Deep RCM vendor partnership drives better collections, efficiency
New KLAS report reveals providers using at least three RCM modules from one vendor gain workflow efficiencies and better cash flow, but integration challenges persist for some.
-
Pharma loses appeal to change 340B drug discounts to rebates
Major drugmakers lost their bid to impose rebate models on 340B providers, as a court ruling states that only the HHS can authorize changes to the drug discount program structure.
-
Why providers can't get paid for using clinical AI tools
Healthcare payment models aren't built for AI, say industry leaders in a new report, which proposes a reimbursement framework as CMS launches a model to pay for technology-enabled care.
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Physician pay cuts loom as CMS unveils major Medicare reforms
The 2027 Medicare Physician Fee Schedule rule would cut conversion factors, sunset traditional MIPS and overhaul the Medicare Shared Savings Program despite provider pushback on costs.
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Care continues shift to outpatient as hospital margins dip
Outpatient revenue jumped 8% YTD while operating margins fell to 2.7% in May, prompting strategic changes, Kaufman Hall reports.
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REACH ACOs save $2.5B as model prepares for LEAD shift
REACH ACOs achieved $2.5B in gross savings with a 6.7% rate in 2024, as 96 of 115 ACOs earn net savings as the model prepares to transition to LEAD in 2027.
Features
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Amid staffing shortages, AI becomes medical coding's backup hire
Even competitive providers like UC Davis Health now use AI to support thinning medical coding teams, creating more tech-driven workflows and a fundamental shift in the workforce.
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New No Surprises Act rules won't fix $51M crisis, TX group says
Radiology Associates of North Texas expects to pay millions to participate in the No Surprises Act's IDR process even as CMS tries to alleviate major pain points for providers.
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The U.S. finally bent the healthcare cost curve, one economist says
Health economist David Cutler's new analysis shows a deceleration in U.S. healthcare spending as technology advancements make care cheaper.
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How AI scribes are shifting coding intensity, reimbursement
The proliferation of AI scribes for clinical documentation has started a shift in coding intensity, raising concerns about reimbursement and affordability.