New & Notable
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.
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.
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.
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.
Jefferson Health sues Aetna over Medicare Advantage ‘downcoding’ policy
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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.
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RCM Management
ZOLL Data Systems
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Cybersecurity
Commvault + Microsoft
Together, Commvault and Microsoft are redefining cybersecurity and data resilience with a comprehensive, integrated platform, purpose-built to secure, defend, and recover data wherever it lives with true cloud simplicity, intelligence, and scale.
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.
View All Episodes
Latest News
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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.
-
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.
-
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.
-
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.
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Cedar goes beyond propensity to pay to bolster patient billing
The healthcare financial engagement company is expanding AI capabilities to deliver more personalized patient billing experiences at scale.
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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.
Features
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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.
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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.
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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.
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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.