New & Notable
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.
HHS revives 340B rebate model despite hospital pushback
HHS released a revised 340B rebate model pilot after losing legal challenges that blocked a similar program earlier this year.
CMS finalizes 2.3% inpatient pay bump, CJR Model expansion
The final rule for the FY 2027 IPPS will increase inpatient payments by about $2.1B and introduce a new mandatory bundled payments model for nearly all hospitals.
CMS locks in 2%+ payment bumps for SNFs, post-acute care providers
Skilled nursing, inpatient rehab and inpatient psych facilities, as well as hospices, all got payment rate updates over 2% as the CMS continues to crack down on fraud in new rules.
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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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Healthcare
Huron
Change is constant in healthcare, and its speed is accelerating. Huron works with healthcare organizations every day to strengthen and innovate their businesses and build more resilient operations to thrive now and in the future.
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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HHS revives 340B rebate model despite hospital pushback
HHS released a revised 340B rebate model pilot after losing legal challenges that blocked a similar program earlier this year.
-
CMS finalizes 2.3% inpatient pay bump, CJR Model expansion
The final rule for the FY 2027 IPPS will increase inpatient payments by about $2.1B and introduce a new mandatory bundled payments model for nearly all hospitals.
-
CMS locks in 2%+ payment bumps for SNFs, post-acute care providers
Skilled nursing, inpatient rehab and inpatient psych facilities, as well as hospices, all got payment rate updates over 2% as the CMS continues to crack down on fraud in new rules.
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Mobile charge capture comes to athenahealth platform
As financial pressures mount, athenahealth integrates mobile charge capture into its EHR platform to help practices keep revenue that's often lost during hospital rounding.
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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.
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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.
Features
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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.
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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.