By Matthew Hawley – Artificial intelligence has been touted as a “solution” to modernize many payers’ processes and functions, including their traditional payment integrity programs. Yet seeing AI as the answer to health plans’ administrative burdens is overly simplistic.
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By Noel Felipe – With high labor costs, low margins and claims denial rates averaging almost 15%, according to the American Hospital Association, providers need new approaches to effective revenue cycle management. Automation and AI tools can increase productivity, reduce the cost to collect and accelerate revenues.
By Matt Bridge – Efficient patient access operations are paramount for healthcare provider organizations to thrive in today’s tumultuous financial landscape. Inefficiencies created by outdated, time-consuming, and cost-intensive patient access and financial clearance operations create delays in the patient’s journey from…
We rounded up some industry experts to comment on The 2025 Employer Health Care Strategy Survey that explored ways employers address health care costs and key benefit strategy considerations in the near future and long-term.
Reported payers and health insurance industry news from Aetna, Cohere Health, Oscar Health, UnitedHealthcare, Centene, AHIP, HealthEdge, Anthem Blue Cross and Blue Shield, CVS Health, Cigna, Humana, CareFirst BlueCross BlueShield, Independence Blue Cross, and more.
By Mike Lanza – In the stop-loss industry, on occasion there can be tension between the Claim Payer (payer or TPA) and the Stop-Loss carrier when it comes to determining reimbursing claims that exceed the specific deductible. Most claims payers have a claims review process in place to ensure that claims payment follows the Employer’s Plan document.
By Dr. Gavin Magaha PharmD MS – The current turmoil surrounding the 340B Drug Pricing Program and Medicaid Drug Rebate Program. Bloomberg Law, recently reported that pharmaceutical manufacturers and a trade organization have filed at least 23 that extend 340B drug discounts to an unlimited number of contract pharmacies.
By Justin Barnes & Greg Fulton – Explaining new CMS policy allowing concurrent CCM and RPM billing for qualified patients, and examination of how chronic care dominates healthcare spending and the opportunity to embark on value-based care revenue streams through MIPS and ACO programs.
By Richa Jain – While it is clear that technology is opening new horizons for medical practices, we can’t ignore the fact that healthcare RCM is one sprawling operation; it encompasses processes starting from patient registration to collections and needs a tech overhaul.