Claims reimbursement
Providers rely on payer reimbursement to cover the costs of providing healthcare services. Without timely and complete reimbursement, providers may struggle to maintain operations. Effective claims management helps to reduce errors and minimize fraud risk while streamlining the reimbursement process to decrease denials.
Top Stories
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News
24 Sep 2026
Oracle Health launches 5 AI revenue cycle tools to prevent denials
Oracle Health will roll out five embedded AI capabilities in its revenue cycle solutions that target prior authorizations, coding and charge capture to prevent claim denials. Continue Reading
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23 Sep 2026
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. Continue Reading
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22 Sep 2026
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. Continue Reading
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17 Sep 2026
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. Continue Reading
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16 Sep 2026
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. Continue Reading
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14 Sep 2026
Conifer to lay off over 1,000 workers
The layoffs come months after CommonSpirit announced it was ending its service contract early and exiting its stake in the Tenet-owned revenue cycle company. Continue Reading
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10 Sep 2026
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. Continue Reading
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09 Sep 2026
Medical supply companies banned in $3.4B fraud takedown
Eleven medical supply companies will not receive Parts C or D payments following a CMS crackdown on potential fraudulent, wasteful and abusive billing. Continue Reading
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31 Aug 2026
Providers warn of another decade of 340B payment problems
Leading provider associations are urging the CMS to reconsider severe cuts to 340B reimbursements to hospitals, warning of another decades-long payment battle. Continue Reading
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27 Aug 2026
$15.6B provider payouts fuel surge in No Surprises Act costs
Arbitrators awarded providers $15.6B from 2023-2025 under the No Surprises Act, with median payments at 445% of the QPA, which researchers say could drive up premiums. Continue Reading
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26 Aug 2026
Hospital rate caps could slash health costs by $1T over a decade
A new Urban Institute study finds capping hospital rates at 100% over Medicare prices could reduce U.S. healthcare spending by $114.8B annually and over $1T in 10 years. Continue Reading
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25 Aug 2026
Hospitals feel payer mix shifts as uncompensated care costs grow
New hospital financial performance data show higher uncompensated care costs and ED visits than two years ago, as healthcare coverage reform takes effect. Continue Reading
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24 Aug 2026
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. Continue Reading
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20 Aug 2026
Survey: Front-end workflows to blame for most claim denials
Insurance eligibility and benefits verification, prior authorizations and patient registration errors are the top drivers of claim denials, according to RCM leaders in a new survey. Continue Reading
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19 Aug 2026
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. Continue Reading
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18 Aug 2026
R1 to acquire Humata Health for AI-driven prior authorizations
The acquisition, expected to close later this year, will leverage agentic AI to accelerate the prior authorization process and bring R1 closer to an autonomous revenue cycle platform. Continue Reading
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17 Aug 2026
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. Continue Reading
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14 Aug 2026
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. Continue Reading
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04 Aug 2026
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. Continue Reading
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03 Aug 2026
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. Continue Reading
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31 Jul 2026
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. Continue Reading
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31 Jul 2026
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. Continue Reading
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29 Jul 2026
CMS fraud war room stops $203M in debated Medicaid payments
In less than 90 days, the new Medicaid Fraud War Room blocked payments to 50 unique providers at high-risk of defrauding the federal healthcare program, the CMS says. Continue Reading
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29 Jul 2026
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. Continue Reading
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28 Jul 2026
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. Continue Reading
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27 Jul 2026
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. Continue Reading
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23 Jul 2026
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. Continue Reading
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21 Jul 2026
Why providers can't get paid for using clinical AI tools
Healthcare payment models aren't built for AI, say industry leaders in a new report, which proposes a reimbursement framework as CMS launches a model to pay for technology-enabled care. Continue Reading
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20 Jul 2026
Doc pay, price transparency on Congress’ healthcare agenda
Lawmakers introduced or advanced a raft of health legislation this week in advance of the midterm elections. Continue Reading
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15 Jul 2026
Physician pay cuts loom as CMS unveils major Medicare reforms
The 2027 Medicare Physician Fee Schedule rule would cut conversion factors, sunset traditional MIPS and overhaul the Medicare Shared Savings Program despite provider pushback on costs. Continue Reading
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14 Jul 2026
Care continues shift to outpatient as hospital margins dip
Outpatient revenue jumped 8% YTD while operating margins fell to 2.7% in May, prompting strategic changes, Kaufman Hall reports. Continue Reading
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06 Jul 2026
CMS proposes expanded authority to revoke Medicare privileges
CMS proposes expanding its authority to revoke Medicare providers in fraud crackdown, while updating home health payments with a 2.4% increase and continued PDGM adjustments. Continue Reading
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02 Jul 2026
CMS takes aim at 340B, site-neural payments in OPPS proposal
The proposed Hospital Outpatient Prospective Payment System rule also includes a 2.4% rate boost, prior authorization for Botox injections and a more aggressive 340B remedy plan. Continue Reading
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29 Jun 2026
Provider compensation grew, but productivity outpaced pay
New data from AMGA shows a 4.3% bump in provider compensation last year, driven by productivity growth rather than reimbursement increases. Continue Reading
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25 Jun 2026
How the U.S. spent $5.7T on healthcare
A new analysis from federal actuaries shows another year of U.S. healthcare spending growth over 7%, but legislative reform will temper healthcare's acceleration, they say. Continue Reading
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22 Jun 2026
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. Continue Reading
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18 Jun 2026
Revenue cycle AI, IDR disputes drive 9% medical cost trend
The medical cost trend is reaching its highest level in nearly two decades as AI-enabled coding and provider wins under the IDR process inflate costs, PwC says. Continue Reading
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17 Jun 2026
Reports say Ensemble is close to a $12B private equity bid
New reports say the firm founded by executive Matt Holt is close to a $12 billion acquisition of Ensemble Health Partners, marking another landmark deal in the RCM sector. Continue Reading
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11 Jun 2026
AMA takes aim at AI prior auth in policies to ensure physician oversight
The AMA's House of Delegates has adopted policies to ensure physician oversight of AI-based clinical decision support and coverage decisions. Continue Reading
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09 Jun 2026
FinThrive bets AI can prevent denials with new product
A new product from FinThrive uses AI to get ahead of claim denials, using data from real-world payer behavior as the company undergoes another financial restructuring. Continue Reading
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04 Jun 2026
Athenahealth unveils over 80 revenue cycle AI features
The company announced its revenue cycle management roadmap, including new AI capabilities in its flagship platform for prior authorizations, coding and denial resolution. Continue Reading
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26 May 2026
Innovaccer keeps humans in the loop with CaduceausHealth deal
Innovaccer's latest acquisition supports its autonomous revenue cycle goals, while also underscoring the role RCM experts play in getting there. Continue Reading
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21 May 2026
CMS proposes new cap on supplemental Medicaid payments
The proposed rule would align state-directed Medicaid payments with Medicare rates in a move to save $775B over the next ten years. Continue Reading
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20 May 2026
Private payer rates outpaced Medicare's by 47%: KFF
New data shows a widening gap between what private payers and Medicare pay for hospital care as lawmakers blast hospitals for rising costs and seek reform. Continue Reading
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18 May 2026
The 'corporate takeover' of physician practices accelerates: study
A new report details nearly a decade of hospitals and corporations buying physician practices, leaving just 18% of physicians practicing in physician-owned settings. Continue Reading
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14 May 2026
Physicians skeptical of insurer pledges to reform prior authorization: survey
Only 33% of physicians surveyed by the American Medical Association said they believed voluntary pledges made by insurers last year to reform prior authorization would result in meaningful difference. Continue Reading
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14 May 2026
Feds hold states to the fire over Medicaid fraud as CA loses $1B
The White House wants proof that states are aggressively pursuing Medicaid fraud, threatening to stop funding if they don't take it seriously enough. Continue Reading
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12 May 2026
AMA, providers seek stricter enforcement of No Surprises Act
The AMA and nearly 100 other groups are backing legislation that would force payers to comply with IDR payment determination rules as providers continue to report nonpayment. Continue Reading
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06 May 2026
California hospitals sue Elevance over out-of-network penalty
The lawsuit seeks to block Elevance's expansion of its policy in California, which would penalize facilities with a 10% fee if care is delivered by an out-of-network physician. Continue Reading
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06 May 2026
CMS Health Tech Ecosystem adds electronic prior auth pledge
A new Health Tech Ecosystem pledge aims to bring together various healthcare stakeholders to advance electronic prior authorizations and ease the burdens associated with the process. Continue Reading
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05 May 2026
United promises another 30% cut to prior auths in 2026
United will eliminate prior authorizations for more outpatient, chiropractic and diagnostic care this year as part of a pledge to streamline the process. Continue Reading
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04 May 2026
DOJ forms West Coast Strike Force to stop healthcare fraud
In the administration's latest healthcare fraud crackdown, it created a West Coast Strike Force to root out fraud, waste and abuse in Arizona, Nevada and Northern California. Continue Reading
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30 Apr 2026
Skin substitute spending driven by patients, products, prices
A new analysis shows continued growth in Medicare's skin substitute spending, driven by higher prices, more patients and greater product use. Continue Reading
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30 Apr 2026
OIG: CMS paid millions in improper virtual care payments
A new audit reveals that CMS paid more than $2 million for virtual check-ins and e-visit services over a four-year period. Continue Reading
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28 Apr 2026
AMA alerts officials of health plans' No Surprises Act abuse
More than 100 provider groups call for greater enforcement of the No Surprises Act after accusing health plans of circumventing its intent and raising patient costs. Continue Reading
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27 Apr 2026
Payers promise standardized electronic prior auths
After announcing an 11% reduction in prior authorizations, major payers are now focusing on standardizing an electronic request process. Continue Reading
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24 Apr 2026
CMS accelerates Medicare coverage for breakthrough medical devices
The agency and FDA announced a new Medicare coverage pathway for certain breakthrough medical devices that cuts the reimbursement timeline from 1+ years to months. Continue Reading
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23 Apr 2026
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. Continue Reading
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22 Apr 2026
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. Continue Reading
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20 Apr 2026
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. Continue Reading
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16 Apr 2026
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. Continue Reading
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15 Apr 2026
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. Continue Reading
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14 Apr 2026
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. Continue Reading
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13 Apr 2026
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. Continue Reading
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08 Apr 2026
Jefferson Health sues Aetna over Medicare Advantage ‘downcoding’ policy
The health system claims the policy, which reduces reimbursement for some inpatient hospital stays, violates federal law and its reimbursement contract with Aetna. Continue Reading
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08 Apr 2026
Major payers say they cut prior authorizations by 11%
Major Blues plans, Cigna, Humana and United are among the payers reporting reduced prior authorizations amid an industry-wide push to streamline the process. Continue Reading
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07 Apr 2026
Waystar tackles $40B denials problem with new AI capability
As part of creating an autonomous revenue cycle, Waystar is now using AI to identify silent denials from post-payment adjustments. Continue Reading
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06 Apr 2026
CMS proposes Medicare payment rules for SNFs, 3 others
CMS is seeking to increase payments to skilled nursing facilities, hospices and inpatient rehabilitation and psychiatric facilities next year, while cracking down on hospice fraud. Continue Reading
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03 Apr 2026
OpenEvidence enters prescription, prior auth arena
Through a new partnership with Tandem, the clinical decision support platform will include automation capabilities to ease the prescription and prior authorization processes. Continue Reading
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02 Apr 2026
Hospitals lost over $48B from claims denials, uncollected bills
Revenue leakage worsened for hospitals in 2025, as payers denied more claims and bad debt increased significantly, according to a new report. Continue Reading
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01 Apr 2026
Over 130 hospitals sue HHS over DSH payments
Hospitals in 16 states have sued the department, arguing a 2023 final rule underpays hospitals that treat a disproportionate number of low-income patients. Continue Reading
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01 Apr 2026
Ensemble, Cohere partner on LLM for revenue cycle management
Ensemble said it will build a revenue cycle management-native LLM with the enterprise AI company to manage specific RCM workflows and payer rules. Continue Reading
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31 Mar 2026
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. Continue Reading
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26 Mar 2026
Adonis raises $40M to accelerate AI in revenue cycle
With users like Mount Sinai Health System, Adonis raised $40M in Series C funding to further drive the application of AI in its revenue cycle platform. Continue Reading
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24 Mar 2026
AMA: Blended physician compensation model prevails
New data from the American Medical Association reveals major changes in physician compensation, with a blended model based on salary and productivity being most popular. Continue Reading
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23 Mar 2026
CMS vows to ditch faxes for electronic claims attachments
A new final rule would establish standards for the electronic exchange of claim attachments for all HIPAA-covered entities by 2028. Continue Reading
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18 Mar 2026
CMS to install centralized IDR platform for disputes
Coming later this year, the IDR Gateway will provide a centralized platform for managing claims under the independent dispute resolution process. Continue Reading
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17 Mar 2026
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. Continue Reading
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12 Mar 2026
AHA: Hospitals spent $43B chasing pay from denials, prior auths
Hospitals are spending precious resources on administrative burdens as expenses continue to rise significantly, the AHA reports. Continue Reading
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11 Mar 2026
Agentic AI powers revenue cycle technology news at HIMSS26
A common theme at HIMSS26 is using agentic AI to coordinate tasks across the revenue cycle, pushing a more autonomous state of management. Continue Reading
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05 Mar 2026
As financial standing improves, physicians worry about sustaining it
Most physicians are confident in their practice's financial footing, but those in independent practice still have an overwhelming fear of losing that status as financial pressures mount. Continue Reading
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25 Feb 2026
New report shows NSA is working. So, why are payers, providers still mad?
A new report suggests greater in-network participation since the No Surprises Act, but more work needs to be done to iron out the law's wrinkles for major stakeholders. Continue Reading
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24 Feb 2026
GOP’s ‘Big Beautiful Bill’ erases 12 years of solvency for Medicare trust fund: CBO
Congressional scorekeepers expect the Hospital Insurance trust fund to run dry more than a decade earlier than they previously expected, after the Republican megabill slashed the revenues it receives. Continue Reading
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23 Feb 2026
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. Continue Reading
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17 Feb 2026
HHS revives 340B rebate model idea, seeks industry feedback
HHS is seeking industry feedback on implementing a 340B rebate model after it scrapped a similar pilot earlier this month. Continue Reading
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12 Feb 2026
41% of rural hospitals in red ahead of Medicaid policy shift
Fewer U.S. rural hospitals are operating at a loss, but sweeping Medicaid reform over the next few years could offset these small financial improvements. Continue Reading
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09 Feb 2026
Site-neutral payments would slash hospital funds by $182B
An analysis shows that expanding site-neutral payments would cut Medicare reimbursement to hospitals, threatening access to care. Continue Reading
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05 Feb 2026
Abridge, Microsoft earn top spots for revenue cycle tech
KLAS released its list of top vendor solutions for health IT, including revenue cycle management technology and services. Continue Reading
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04 Feb 2026
Nearly 45% of healthcare payments tied to APMs: Survey
The latest healthcare payments data shows stable participation in alternative payment models, although there was little growth in risk-based payments. Continue Reading
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04 Feb 2026
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. Continue Reading
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28 Jan 2026
Half of providers report revenue losses from credentialing delays
Credentialing delays are costing some hospitals over $1M annually as provider organizations face workforce challenges and manual processes. Continue Reading
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22 Jan 2026
Medicaid improper payments increase, reaching $37.39B
Medicaid, CHIP and Medicare Advantage all saw increases in improper payment rates in FY 2025, while Medicare fee-for-service's rate remained below 10%. Continue Reading
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21 Jan 2026
Trinity Health to lay off 10.5% of revenue cycle headcount
The Michigan-based health system said financial headwinds, including heightened costs, low reimbursement and federal policy changes, motivated the cuts. Continue Reading
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20 Jan 2026
R1 adds prior authorization solution to new revenue cycle OS
R1 announced a new prior authorization solution as part of the Phare OS that seek to automate and scale the process for faster decisions with minimal human touch. Continue Reading
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20 Jan 2026
Healthcare leaders expect AI maturity this year, especially in RCM
A new report shows low AI maturity despite widespread adoption in the revenue cycle. Still, leaders expect to mature rapidly over the next year or two as they confront data constraints. Continue Reading
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13 Jan 2026
Waystar adds agentic AI in move to 'autonomous' revenue cycle
The healthcare payment software vendor announced new agentic AI capabilities as part of its journey to make the revenue cycle autonomous. Continue Reading
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12 Jan 2026
How providers can prepare for the upcoming telehealth cliff
Telehealth flexibilities are set to expire on Jan. 30, 2026, but there are strategies that can help healthcare providers navigate the ongoing uncertainty. Continue Reading
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12 Jan 2026
Abridge partners with Availity for AI-powered prior authorizations
Abridge took its next step in powering prior authorizations with AI; this time, the company teamed up with Availity to use conversational intelligence for real-time prior authorizations. Continue Reading
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06 Jan 2026
Benchmark prices under NSA far below actual median rates: Study
Qualifying payment amounts used under the No Surprises Act are, on average, a third of the payers' contracted in-network rates, according to a study. Continue Reading
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05 Jan 2026
Hospitals aren't ringing in a new 340B rebate program
Hospitals are applauding a federal court's ruling to halt the Jan. 1 implementation of a rebate model pilot in the 340B Drug Pricing Program, which they claim would cost north of $400M. Continue Reading
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16 Dec 2025
More primary care practices ditch insurance for direct care
A study reveals an increasing number of practices and clinicians transitioning to concierge and direct primary care models in a move that cuts medical billing's administrative burden. Continue Reading
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02 Dec 2025
Home health agencies face 1.3% decrease in Medicare payments
CMS finalized the CY 2026 Medicare payment rates for home health agencies, issuing a significantly smaller cut to payments than the $1.135 billion proposed reduction. Continue Reading