Susan Morse

ROI shows fairly quickly and tools can be used right away to advance from simple to more complex cases, says Jeff Francis, CFO and VP for the Methodist Health System.

"Despite efforts in MACRA to move past annual 'doc fixes' … we have continued to see physician payment instability in the Medicare program,” the committee said.

A quarter of financial executives are concerned about AI errors and an increased dependency on external partners, says HFMA survey.

Complaints claim CVS Health and its affiliates pocketed 340B Drug Program savings.

“The days of someone sitting down and reading every piece of documentation in every encounter … we can’t staff to that," Powers says.

The not-for-profit insurer said it is exiting the individual market across all states and the state of Montana across all lines of business.

Payers have to address over-payments from every computer click and providers need to offset denials by deploying AI for the mid-cycle, says revenue integrity expert.

The Centers for Medicare and Medicaid Services and other agencies have finalized a rule that is expected to reduce the number of ineligible payment disputes in the No Surprises Act Independent Dispute Resolution process.More than 5 million disputes have gone to the Independent Dispute Resolution (IDR) process since it was launched in April 2022. This far exceeded expectations, creating delays and unnecessary costs, CMS said.

Insurer is eliminating prior auth for many diagnostic procedures, routine surgeries and for cardiology, neurology, pulmonology and orthopedic specialty care.

AI-driven business and enterprise strategy means the right type of people are needed at the table, says Dr. Deepti Pandita, CMIO and chief AI officer at the University of California Irvine.