What Healthcare Organizations Miss When It Comes to Reimbursement Accuracy
At the end of the day, the most important question is a simple one: Do you actually know if you’re being reimbursed correctly?
Why CMS Is Trying to Ban Third-Party Remote Patient Monitoring
CMS' proposed 2027 Physician Fee Schedule would bar Medicare payment for remote monitoring services delivered by third-party vendors, following OIG reports that flagged widespread fraud in the space.
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Top 7 Modern AI-Powered EAP Providers for Global Workforces in 2026
Discover the top AI-powered EAP providers for 2026. Compare platforms like Kyan Health and Spring Health on triage speed, global reach, and clinical quality to transform workforce wellbeing.
Why ‘Still Open’ Is the Wrong Way to Measure the Hospital Crisis
Counting hospital closures only tells part of the story, noted Duane Fitch, partner at Plante Moran. Across the country, hundreds of hospitals remain technically open while steadily shedding services their communities depend on, such as emergency care, obstetrics and psychiatric care.
The Evolving Medical Practice: How Doctors Can Adapt and Prosper In a Changing Environment
Building a medical practice that’s truly resilient can feel like pushing a rock up a hill. However, physicians who are ready, willing and able to stay adaptable and seize opportunities will give their medical practices staying power.
The Success Triangle: What MedTech Startups Can’t Ignore
Innovators who holistically develop their products, studies, and payment strategy with these things in mind will reduce risks, spend less, and reach profitability sooner.
Reimbursing Your Digital Twin: A New Era In Patient-Specific Surgery
Deploying AI-driven segmentation at an enterprise level goes beyond operational efficiency. It signals a commitment to pioneering the next era of precision healthcare.
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New Webinar: The Payer AI Readiness Gap: Why Better Data Will Define the Next Era of Health Plan Performance
We'll explore why the next era of payer performance will depend on building a trusted data foundation that connects people, providers, and relationships across the enterprise.
Workload Up, Payment Down: The Growing Strain on Independent Practices
Physicians are facing rising workloads, shrinking support staff and declining reimbursement — resulting in a burnout crisis and threatening the sustainability of independent practices. Experts say urgent Medicare payment reforms are needed to prevent further consolidation, as well as preserve access to care.
Bipartisan Bill Seeks to Establish Parity Between MA & Traditional Medicare Payments
Two U.S. representatives have introduced the Prompt and Fair Pay Act, a bipartisan bill that would require Medicare Advantage plans to reimburse providers at least the same rates as traditional Medicare, as well as pay claims more promptly. Providers and industry groups have welcomed the proposal, citing mounting financial strain and growing concerns over care delays and denials.
Why Hospitals Are Losing the Financial Tug-of-War With Payers
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.
New Legislation Seeks to Preserve Hospital-at-Home Reimbursement Until 2030
A bipartisan group of lawmakers introduced legislation this week to extend CMS’ hospital-at-home waiver for five more years, allowing hospitals to continue delivering acute care in patients’ homes with Medicare reimbursement. The move comes as research shows this model reduces mortality and healthcare costs.
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The Healthcare Payments Industry Faces a Perception Challenge
Healthcare payments are no longer about transactions. It’s about controlling the revenue cycle. And increasingly, that control is not sitting with ISOs.
Eko Health’s AI for Cardiac Diagnoses Earns CMS Reimbursement Rate
This week, CMS established a reimbursement code for Eko Health’s AI platform, which seeks to aid clinicians in the diagnosis of heart conditions. The goal behind the technology is to help catch heart disease earlier, when it’s easier to treat, and to make high quality diagnostic care more accessible.
INVEST Pitch Perfect Spotlight: How Pear Suite Makes Sure Community Health Workers Get Paid
Pear Suite recently won the payer/provider technology track of MedCity News’ INVEST Pitch Perfect contest. The startup provides a software platform for community health workers that helps them share data, submit claims and maintain compliance.
Labor Costs and Payer Rates Are Still Squeezing Providers’ Margins
New research found that most healthcare CFOs anticipate minimal financial gains this year due to high labor costs and insufficient payer rates. While providers are leveraging more data to improve financial planning, persistent challenges like wage pressures, recruiting difficulties and payers' increasing use of technology to deny claims continue to strain margins.
High Labor Costs Continue to Plague Providers, Data Shows
High labor costs remain an ongoing problem threatening providers’ bottom lines, according to new data from Kaufman Hall. The research revealed that medical groups’ median investment in each employed physician has reached more than $300,000 for the first time.
Increasing Efficiency and Reimbursements with Clearinghouses
Clearinghouses are just one great example of how the enhanced exchange of healthcare data can increase efficiency for healthcare providers and the greater healthcare community.