Billing frustration isn’t just a provider problem; it’s a patient problem too. Every delayed claim, every error, every confusing denial ultimately affects the person receiving care. Now AI can reduce that friction.
AI and advanced analytics can help organizations move beyond incremental fixes, streamlining access and improving patient experience, without overburdening staff or budgets.
What if health plans could identify member decline before an avoidable hospitalization occurs? Real-time clinical visibility into long-stay SNF members uncovers risk earlier and drives better outcomes.
Medical coding startup Arintra raised $21 million in Series A funding to help hospitals and physician groups secure accurate, timely reimbursement. The company’s AI-powered platform automates coding, spots documentation gaps and generates claims tailored to specific payers.
The real issue isn’t one payer, one policy or one bad actor. It’s a deeply fragmented system built on competing incentives, misaligned responsibilities and layers of administrative friction.
Hospitals’ flat revenues are clashing with rising costs and excessive reimbursement denials from payers, said Rod Hanners, CEO of Keck Medicine of USC. He warned that policy efforts focused solely on limiting provider payments ignore the larger issue of unchecked profits among payers, drugmakers and other healthcare industry players.
How do we tip the scale to lower the rate of denials? While AI has been the initial decision-maker for years, it must become better trained. And to do that, it needs help.
Healthcare payments are no longer about transactions. It’s about controlling the revenue cycle. And increasingly, that control is not sitting with ISOs.
Patients should know exactly what's covered and what it costs before receiving care. Doctors should be empowered to make medical decisions without interference from insurance companies. And the entire process should be designed to facilitate care, not obstruct it.
The operational benefits of automated eligibility and payment workflows are clear, but its impact on people — both patients and staff — may be even more profound.
About one in five in-network claims were denied by insurers of qualified health plans on HealthCare.gov in 2023, according to KFF. There is also wide variation by insurer and state.