New & Notable
$15.6B provider payouts fuel surge in No Surprises Act costs
Arbitrators awarded providers $15.6B from 2023-2025 under the No Surprises Act, with median payments at 445% of the QPA, which researchers say could drive up premiums.
Waystar expands AI-powered agentic revenue cycle tools
The company said its AI agents can now tackle claim resolution, conversational performance intelligence, agentic clinical documentation and the patient financial experience.
Hospital rate caps could slash health costs by $1T over a decade
A new Urban Institute study finds capping hospital rates at 100% over Medicare prices could reduce U.S. healthcare spending by $114.8B annually and over $1T in 10 years.
Hospitals feel payer mix shifts as uncompensated care costs grow
New hospital financial performance data show higher uncompensated care costs and ED visits than two years ago, as healthcare coverage reform takes effect.
Sponsored 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
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.
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.
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Latest News
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$15.6B provider payouts fuel surge in No Surprises Act costs
Arbitrators awarded providers $15.6B from 2023-2025 under the No Surprises Act, with median payments at 445% of the QPA, which researchers say could drive up premiums.
-
Waystar expands AI-powered agentic revenue cycle tools
The company said its AI agents can now tackle claim resolution, conversational performance intelligence, agentic clinical documentation and the patient financial experience.
-
Hospital rate caps could slash health costs by $1T over a decade
A new Urban Institute study finds capping hospital rates at 100% over Medicare prices could reduce U.S. healthcare spending by $114.8B annually and over $1T in 10 years.
-
Hospitals feel payer mix shifts as uncompensated care costs grow
New hospital financial performance data show higher uncompensated care costs and ED visits than two years ago, as healthcare coverage reform takes effect.
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Survey: Front-end workflows to blame for most claim denials
Insurance eligibility and benefits verification, prior authorizations and patient registration errors are the top drivers of claim denials, according to RCM leaders in a new survey.
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R1 to acquire Humata Health for AI-driven prior authorizations
The acquisition, expected to close later this year, will leverage agentic AI to accelerate the prior authorization process and bring R1 closer to an autonomous revenue cycle platform.
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.