New & Notable
Health systems test real-time prior auths through Epic
Epic announced a new prior authorization API that four health systems are currently using to give clinicians and staff real-time access to requirements at the time of scheduling.
Appeals court overturns No Surprises Act QPA calculation method
The 5th Circuit court struck down key factors insurers use to calculate payment amounts under the No Surprises Act, siding with providers who argued rates were artificially low.
Cedar deploys agentic AI for patient billing, financial experience
Patients are increasingly responsible for paying their medical bills, Cedar said, making it imperative for the company to boost the patient financial experience.
Value-based mandates linked to higher hospital admin costs
A study linked mandatory value-based payment models, like the CJR Model, to $3B in additional administrative costs for hospitals.
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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.
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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
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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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Health systems test real-time prior auths through Epic
Epic announced a new prior authorization API that four health systems are currently using to give clinicians and staff real-time access to requirements at the time of scheduling.
-
Appeals court overturns No Surprises Act QPA calculation method
The 5th Circuit court struck down key factors insurers use to calculate payment amounts under the No Surprises Act, siding with providers who argued rates were artificially low.
-
Cedar deploys agentic AI for patient billing, financial experience
Patients are increasingly responsible for paying their medical bills, Cedar said, making it imperative for the company to boost the patient financial experience.
-
Value-based mandates linked to higher hospital admin costs
A study linked mandatory value-based payment models, like the CJR Model, to $3B in additional administrative costs for hospitals.
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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.
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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.
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.