New & Notable
R1 adds AI utilization management for denial prevention
The company's new Phare Utilization Management tool layers payer-specific intelligence onto a clinical AI engine to identify medical necessity denials in real time.
Medicare cuts will jeopardize physician practices, groups say
Healthcare providers slammed planned reductions to Medicare physician reimbursement next year, while supporting more structural changes to how the program pays them.
HHS adds new IDR entity as surprise billing disputes surge
The federal government certified Physio Solutions, which does business as Medlitix, as the 17th arbiter in the No Surprise Act’s independent dispute resolution process.
— Healthcare Dive
Conifer to lay off over 1,000 workers
The layoffs come months after CommonSpirit announced it was ending its service contract early and exiting its stake in the Tenet-owned revenue cycle company.
— Healthcare DiveMedicaid losses leave more patients paying cash, Epic finds
— Healthcare DiveSponsored Sites
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Latest News
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R1 adds AI utilization management for denial prevention
The company's new Phare Utilization Management tool layers payer-specific intelligence onto a clinical AI engine to identify medical necessity denials in real time.
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Medicare cuts will jeopardize physician practices, groups say
Healthcare providers slammed planned reductions to Medicare physician reimbursement next year, while supporting more structural changes to how the program pays them.
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Hospital price transparency compliance improves, but lags at 49%
Experts say clearer communication from CMS and stronger enforcement actions have led to improvements in hospital price transparency compliance.
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New 2027 CPT codes released as AMA faces mounting criticism
The 2027 CPT code set features new AI service codes and a maternity care framework, as the AMA defends its coding system against copyright lawsuits.
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Medical supply companies banned in $3.4B fraud takedown
Eleven medical supply companies will not receive Parts C or D payments following a CMS crackdown on potential fraudulent, wasteful and abusive billing.
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Study: Emergency care costs fall up to 52% after No Surprises Act
A new analysis from HaloMD provides evidence that the No Surprises Act is working to cut costs, with data indicating about $1B in savings from out-of-network emergency care.
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.