New & Notable
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.
Texas hospitals sue Independence Blue Cross over denied claims
Five HCA-affiliated hospitals want over $345,000 in what they say Independence Blue Cross owes them from inappropriate denials under the controversial BlueCard program.
— Healthcare Dive
Medical debt impacts 1 in 3 insured adults
Health insurance coverage doesn't protect everyone from incurring medical debt, with most debt totaling $2,000 or more.
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.
HHS adds new IDR entity as surprise billing disputes surge
— Healthcare DiveConifer to lay off over 1,000 workers
— Healthcare DiveSponsored Sites
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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.
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Latest News
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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.
-
Medical debt impacts 1 in 3 insured adults
Health insurance coverage doesn't protect everyone from incurring medical debt, with most debt totaling $2,000 or more.
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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.
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.