New & Notable
RFK Jr. gives CMS authority to ban individual providers
The head of the CMS can now exclude healthcare providers from receiving federal healthcare funds, an authority once reserved for the HHS OIG.
How Medicare calculates site-neutral rates matters, research says
Site-neutrality is now a question of when, not if, and research shows that how Medicare calculates the rates could affect some service lines more, despite similar overall savings.
Hospital price transparency is clearer, but gaps persist
An analysis finds five persistent issues with hospital price transparency files that continue to hinder price comparisons despite new guidance aiming to clarify costs.
Hospitals sue over revamped 340B rebate pilot
It’s the second time the HHS has tried to kickstart a 340B rebate program — and the second time hospitals have sued to block it, alleging rebates will threaten their financial viability.
— Healthcare DiveSponsored Sites
-
Autonomous Coding
Solventum
-
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.
-
Financial Responsibility
CareCredit
We do something very simple at CareCredit: We help people get the care they want for themselves and their families.
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
-
RFK Jr. gives CMS authority to ban individual providers
The head of the CMS can now exclude healthcare providers from receiving federal healthcare funds, an authority once reserved for the HHS OIG.
-
How Medicare calculates site-neutral rates matters, research says
Site-neutrality is now a question of when, not if, and research shows that how Medicare calculates the rates could affect some service lines more, despite similar overall savings.
-
Hospital price transparency is clearer, but gaps persist
An analysis finds five persistent issues with hospital price transparency files that continue to hinder price comparisons despite new guidance aiming to clarify costs.
-
Healthcare affordability crisis sparks calls for better billing communication
Surveys show consumers need a better patient financial experience, flagging AI as a tool to improve price transparency and communication about medical bills.
-
FTC warns 24 large health systems of price transparency deficiencies
The FTC letters warn of deceptive pricing practices just as the Trump administration revamped healthcare price transparency requirements for payers.
-
AKASA launches AI for autonomous mid-cycle coding
A new solution from AKASA promises to fully code inpatient cases with no human intervention as the company continues to apply advanced AI to the mid-cycle.
Features
-
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.
-
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.
-
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.
-
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.