Appeals and grievances reflect how well a health plan functions under pressure. They also show how effectively your organization can surface, prioritize, and resolve the cases that matter most.
Since its inception, AI in prior auth has only been at work in the commercial healthcare marketplace. Now new innovative approaches that reframe prior auth as a resource instead of a roadblock have come to Medicare via the WISeR model.
We are taking a look at how health insurers are using AI, defining success, and managing cybersecurity risks. Give us your opinions by completing our brief, anonymous survey.
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.
Health systems should take the lead in fixing the broken prior authorization process, said Jeff Balser, CEO of Vanderbilt University Medical Center, during a recent conference. He highlighted AI, better workflows and centralized support as ways to reduce delays.
The real story isn’t about denial rates or stakeholders acting as villains. It’s about a healthcare system that forces intelligent, well-intentioned professionals to make critical decisions in information silos.
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.
Healthcare payments are no longer about transactions. It’s about controlling the revenue cycle. And increasingly, that control is not sitting with ISOs.
While prior authorization has made many headlines over the past year, concurrent review has not. Yet missteps in both processes leave hospitals in danger of not getting paid, which can result in higher costs being passed down to patients.
As AI has evolved to be more accurate and reliable, it's become suitable for high-stakes use cases including automating health insurance verification.
The choices we make now will determine not just the future of healthcare, but the kind of society we leave to our children. Will we continue to allow faceless algorithms to decide who lives and who suffers? Or will we finally reclaim healthcare's moral center and build a system worthy of our highest values?
Brian Thompson's murder was chilling, but the social media response of this tragedy was equally shocking, if eye-opening. It shows a massive collapse of public trust in our healthcare system, a system so broken that it bankrupts families, denies life-saving care, and treats death as an acceptable cost of doing business.
Healthcare decision-makers, especially at pharmaceutical companies, must prioritize patient input. Data collected from social media listening is a significant step in the right direction.
Hospitals are facing increasingly burdensome policies from commercial insurers, leading to problems with cash flow and patient safety. Hospital executives think federal regulators need to enact stricter policies that require payers to operate on faster timelines, as well as provide more transparency into their reasons for denying claims.
Focusing on these areas can help healthcare organizations reduce the incidence of denials, optimize revenue cycle performance and enhance overall patient satisfaction.
Insurers should immediately end their overreach into medical decision-making and work with medical providers and their patients to ensure timely care for all.
Here are six actionable steps healthcare organizations can take to reduce their likelihood of denials and write-offs.
The combination of technology and cross-functional collaboration allows providers to address denials and achieve optimal revenue performance.