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News
The Denial Economy is Asymmetric — and That's the Opening
2+ day, 1+ hour ago (695+ words) The following is a guest article by John Beene, Founder of Soupy AuditOn RAC Extrapolation, Surgical Capacity, and the Math Nobody on the Provider Side is DoingTalk to anyone who has spent a year inside a hospital revenue cycle, and…...
Approved but Underpaid: How Payers are Quietly Redrawing the Rules of Hospital Reimbursement
1+ mon, 2+ week ago (437+ words) The following is a guest article by Missy Harbert, Senior Solution Advisor at Revecore For years, hospitals have built denial management programs around a predictable premise: when a payer disputes a claim, it sends a denial. There is a code,…...
Healthcare Revenue Has a Complexity Problem: Here’s the Cure
1+ mon, 2+ week ago (552+ words) The following is a guest article by Steve Harding, SVP (EMEA & APAC) at Clari and Salesloft At the same time, commercial teams are working through longer buying cycles with more stakeholders involved in every decision. Revenue is harder to track,…...
Why Health Payers Need a Unified Content Strategy
1+ mon, 4+ week ago (128+ words) Ashish Desai, President of Benefits Lifecycle Solutions at Simplify Healthcare, believes that a health care provider should not have to call a payer to plan treatment or submit a bill; he should be self-served through a web search or chat....
Rialtic and Exponential AI Announce Strategic Merger to Transform Healthcare Payment Accuracy and Decision Intelligence
2+ mon, 2+ week ago (207+ words) Together, Rialtic and Exponential AI will offer one of the industry’s most comprehensive suites of products for the claim lifecycle: By uniting these capabilities under one platform, the combined entity removes the friction, waste, and administrative drag that have long…...
Under Pressure: Why Pre-Bill Prevention is Now Non-Negotiable in Coding and Denial Management
2+ mon, 3+ week ago (552+ words) The following is a guest article by Ritesh Ramesh, CEO at MDaudit Healthcare organizations are operating in an environment defined by financial pressure, regulatory scrutiny, and rapid shifts in payer behavior. Leadership teams are expected to maintain financial stability, protect…...
The Hidden Compliance and Revenue Gap in Home Health: 3 Failures Costing Agencies Millions
3+ mon, 1+ week ago (443+ words) The following is a guest article by Matt Saucedo, Founder of ClientCare.pro Home health agencies are losing revenue they have already earned. Not from payer disputes or rate cuts, but from operational gaps that silently drain the bottom line....
Healthcare's Multi-Billion Dollar Fraud Problem Starts at the Front Door - And FaceTec is Closing It
4+ mon, 4+ day ago (442+ words) Healthcare has an identity crisis. Literally, not figuratively. The system bleeds billions in fraud every year. Duplicate records sit in databases like ticking time bombs. We treat patient matching as a back-office headache. It is actually a clinical imperative. The…...
NuvemRx Acquires par8o from R1 RCM, Strengthening its Specialty Care Coordination and 340B Referral Capture Capabilities
5+ mon, 2+ week ago (124+ words) The Acquisition Connects Pharmacy and Referral Intelligence to Help Covered Entities Simplify Workflows, Expand Access, and Grow 340B Savings For more information on how NuvemRx supports community health centers and safety-net providers, please visit nuvemrx.com. NuvemRx helps community health providers…...
Health Plan AI Has a Data Problem, and It’s Costing CFOs More Than They Think
5+ mon, 3+ week ago (694+ words) The following is a guest article by Megan Schmidt, President Chief Executive Officer, Madaket Health plans are pouring capital into automation, analytics, and artificial intelligence, betting that smarter systems will lower administrative costs and improve operational performance. Yet a growing…...