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Payers say AI doesn't deny care. The truth is more complex.
2+ week, 5+ day ago (1197+ words) at Ensemble Health Partners, a revenue cycle management company that handles medical billing and claims management for providers. What payers are saying about AI...
Survey: Front-end workflows to blame for most claim denials
3+ week, 3+ day ago (593+ words) 400 industry leaders conducted by revenue cycle management vendor Inovalon. No other issue, including prior...persistent issues with missing or invalid claim data (35%) and medical coding breakdowns (28%), although...
Providers warn of another decade of 340B payment problems
1+ week, 6+ day ago (779+ words) The American Hospital Association is warning the federal government that history could repeat itself if it finalizes reimbursement cuts to hospitals participating in the 340B Drug Pricing Program. In July, the Centers for Medicare and Medicaid Services proposed significantly cutting reimbursement…...
Employee health benefits to spike 9.5% in 2027
2+ week, 6+ day ago (520+ words) AndreyPopov/istock via Getty Ima Employers can expect to pay 9.5% more for employee health benefits in 2027, with new reporting from professional services firm Aon projecting average employee healthcare costs totaling more than $19,000 in the coming year. These numbers reflect the…...
Can Costco hack Medicare Advantage's consumer loyalty problems?
3+ week, 2+ day ago (945+ words) A new partnership with California-based payer SCAN Health Plan marks Costco's first step into the Medicare Advantage market, as the wholesaler unveiled new branded health insurance plans this week. The deal is scant on details so far, but SCAN did…...
How providers can weather Medicaid cuts when many won't
3+ week, 3+ day ago (1417+ words) Recent Medicaid and Affordable Care Act changes will have a widespread impact on healthcare providers, whether they work for large health systems or small ambulatory practices. However, some types of providers stand to lose more than others, and the effects…...
Hospital rate caps could slash health costs by $1T over a decade
2+ week, 4+ day ago (749+ words) As the U.S. grapples with exorbitantly high healthcare costs, a new study suggests capping hospital rates could reduce overall spending by hundreds of billions of dollars. The U.S. spent $5.7 trillion on healthcare last year, federal actuaries reported in June. This marked the…...
Medical supply companies banned in $3.4B fraud takedown
4+ day, 1+ hour ago (393+ words) Trust Funds and its beneficiaries by using advanced data analytics to identify fraud networks and stop suspicious...Xtelligent Healthcare Media, covering revenue cycle management, healthcare payers, health policy and health...
How employers are rethinking benefits as healthcare costs soar
2+ week, 4+ day ago (806+ words) The data is clear: Employers are facing nearly double-digit healthcare cost growth next year....
Hospitals feel payer mix shifts as uncompensated care costs grow
2+ week, 5+ day ago (743+ words) according to new hospital financial performance data. The data from Kaufman Hall, a Vizient company, shows that...more on EDs for care amid the coverage shifts. The data suggest that hospitals are already facing the repercussions...remained above 7% since March....