New & Notable
Prices rose after No Surprises arbitration for some care: analysis
The data, compiled by the Brookings Center on Health Policy, shows that average prices for some services like imaging were seven-times higher than Medicare prices.
— Healthcare Dive
When brand-name drugs need a prior auth, brace for delays
A study uncovered friction at the pharmacy, revealing days-long delays and frequent denials when brand-name prescription drugs need a prior authorization.
Judge dismisses Aetna’s No Surprises fraud suit against Radiology Partners
The insurer accused the radiology group of gaming the No Surprises Act to reap higher reimbursement. A judge tossed the case last week.
— Healthcare Dive
Before revenue cycle AI, payers and providers need to get along
A survey shows that most providers say disagreements with payers over claims prevent timely and full reimbursement.
Jefferson Health sues Aetna over Medicare Advantage ‘downcoding’ policy
— Healthcare DiveSponsored Sites
-
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.
-
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.
-
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.
Healthcare Strategies: A Podcast
-
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
-
When brand-name drugs need a prior auth, brace for delays
A study uncovered friction at the pharmacy, revealing days-long delays and frequent denials when brand-name prescription drugs need a prior authorization.
-
Before revenue cycle AI, payers and providers need to get along
A survey shows that most providers say disagreements with payers over claims prevent timely and full reimbursement.
-
AI arms race leading to prior auth problems, reimbursement cuts
Early adoption of AI for prior authorizations and medical billing is inflating medical spending, prompting payers to slash reimbursement rates.
-
Judge dismisses No Surprises Act lawsuit against HaloMD
A California federal court threw out Elevance Health's lawsuit against HaloMD, alleging the organization has gamed the No Surprises Act's IDR process for profit.
-
CMS proposes 2.4% IPPS bump, joint replacement model expansion
A proposed rule would increase inpatient reimbursement by $1.9B next year, while expanding the Comprehensive Care for Joint Replacement Model nationwide.
-
Cedar goes beyond propensity to pay to bolster patient billing
The healthcare financial engagement company is expanding AI capabilities to deliver more personalized patient billing experiences at scale.
Features
-
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.
-
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.
-
Agentic AI evolution begins to pave way for autonomous revenue cycle
A fully automated revenue cycle in which staff work hand-in-hand with AI is looming, but success will require a mature AI strategy.
-
How NGHS balances revenue cycle AI adoption, ROI
Northeast Georgia Health System is accelerating AI adoption, especially in revenue cycle management, but leaders have learned to balance speed of innovation with ongoing ROI.