New & Notable
CJR Model's $180M savings pave way for nationwide expansion
Medicare's bundled payment model for joint replacements cut costs by $180 million in its final three years without compromising care quality, according to a new CMS report.
Site-neutral payments could save over $12B
A new analysis from EBRI finds significant cost savings for health plans and employers under site-neutral payments, although patients would have to wait for relief.
8% of hospital-insurer contract disputes go public: study
For-profit hospitals are more likely to publicly threaten to leave an insurer's network, although very few of these disputes end contractual relationships, according to a study.
Insurers say AI could add billions in health costs. Billing companies disagree
Vendors insist their AI-assisted coding tools can correct years of under-documentation, but insurers say the tools are driving up healthcare costs for patients.
— Healthcare DiveTexas hospitals sue Independence Blue Cross over denied claims
— Healthcare DiveSponsored Sites
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Revenue Cycle Management
Brault
Brault is a revenue cycle and practice management organization that partners with hospitals and independent physician groups. Their intelligent practice solutions include coding and billing, MIPS optimization, provider documentation training, and practice management.
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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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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.
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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CJR Model's $180M savings pave way for nationwide expansion
Medicare's bundled payment model for joint replacements cut costs by $180 million in its final three years without compromising care quality, according to a new CMS report.
-
Site-neutral payments could save over $12B
A new analysis from EBRI finds significant cost savings for health plans and employers under site-neutral payments, although patients would have to wait for relief.
-
8% of hospital-insurer contract disputes go public: study
For-profit hospitals are more likely to publicly threaten to leave an insurer's network, although very few of these disputes end contractual relationships, according to a study.
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New analysis points finger at payers for IDR problems
Specialty medical groups submitted an analysis to Congress showing payers are responsible for most provider IDR wins despite their widespread complaints.
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Oracle Health launches 5 AI revenue cycle tools to prevent denials
Oracle Health will roll out five embedded AI capabilities in its revenue cycle solutions that target prior authorizations, coding and charge capture to prevent claim denials.
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Insurers deny less just to claw back more later: analysis
An analysis shows that claim denial rates are falling slightly, but providers aren't necessarily seeing an improvement in revenue as payers seek clawbacks.
Features
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Payers say AI doesn't deny care. The truth is more complex.
Payers say AI is not clicking the deny button on prior authorizations and provider claims, but the technology does play a key role in deciding which requests need further review.
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How providers can weather Medicaid cuts when many won't
Federal Medicaid reform will affect providers differently, with some more at risk of closing while others can innovate their way out of severe revenue losses.
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Prior authorization automation hinges on human connection
Healthcare is rapidly automating the prior authorization process, but Ochsner Health has found that a new initiative connecting payers and providers is making progress tangible.
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What providers really need to streamline prior authorizations
Providers have yet to see much progress on a pledge last year to streamline prior authorizations, signaling misalignment between payer promises and meaningful change for providers.