AI denials are bad news for providers.
A full 61% of physicians fear that unregulated use of artificial intelligence by payers is creating an increase in prior authorization denials [1]. This growing issue directly impacts medical decision making,
FQHC Medical Billing Regulations Should Prompt an Immediate Response From Leadership
FQHC leaders face a time of unparalleled challenges – which creates a need for fresh strategic response. A range of regulations is creating disruption and one of the most pressing areas is in FQHC medical
Why Deregulation Means A Need for Medical Coding Outsourcing
Healthcare revenue cycle leaders are headed into uncharted territory under the new administration, but there are a few signs that can be useful in charting a path forward.
The first Trump administration featured a range of reductions in restrictions and loosening of prior regulations. For the healthcare revenue cycle, it’s impossible to know exactly what’s coming this term, but
Risk Adjustment Coding Needs Innovation
After releasing new HCC coding guidelines, CMS has published the latest Medicare Advantage Rate announcements, sparking speculation around the impact on providers. These potential impacts include shifts in Medicare Advantage enrollment, questions around the effects of changing economic conditions, and increases in payments to Medicare Advantage plans. All of this is unfolding at a time when government spending is under increased criticism – Medicare Advantage plans are known to cost the
Healthcare Leaders Dropping Legacy Systems Have an Opportunity to Explore Outsourcing
Switching out legacy IT systems can be a time of change and disruption for healthcare revenue cycle leaders – but it can also be a time of opportunity. While many leaders will look for ways to identify high-performing replacement solutions or even consolidate technologies, dropping a legacy system is also an excellent time to consider
