The healthcare industry has faced compounding pressures for years. Between staffing shortages putting strain on employee workloads, budget constraints, and ongoing tech modernizations, a solution is needed to ease and improve workloads and improve security, without sacrificing patient experiences. But resource constraints mean many hospitals aren’t prioritizing modern IT upgrades, including the networks that are vital to running day-to-day operations, which could prove to be a costly mistake in
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Demystifying Prepay Coordination of Benefits: A Crucial Component of Payment Integrity
Coordination of benefits (COB) is a key component of any effective payment integrity program. But determining primacy for members with multiple plans and ensuring claims aren’t overpaid can be a complicated process. Whether it’s verifying employment status or sifting through complicated claims, COB takes significant time for peak accuracy. And while health plans focus on the intricacies of an effective COB strategy, many overlook the possibilities that a comprehensive prepay COB solution can
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How Conversational AI is Reinventing Healthcare Patient Access
In healthcare, delivering patient-centered care isn’t just reserved to the confines of a clinic, it begins with the first phone call to schedule an appointment. But far too often, those calls are met with outdated interactive voice response (IVR) systems, long wait times, and puzzling menus that cause frustration rather than support. Alarmingly, according to Market Growth Reports, around 36% of companies still use old IVR software from before 2017, meaning many health providers are lagging
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The Double-Edged Sword: Why AI is Healthcare’s Biggest Cybersecurity Threat Yet
Artificial intelligence (AI) is the ultimate double-edged sword in healthcare. On one side, AI is already driving real improvements, from accelerating diagnostic imaging to streamlining operational workflows such as delivering faster, more accurate, and more efficient patient care. And we are still only at the beginning; AI’s potential to reshape healthcare is undeniable.
But that optimism is tempered by the reality that AI also introduces one of the most significant cybersecurity risks the
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Reimbursement Shift under 2026 PFS Poised to Usher in New Era for RPM
The annual release of the Medicare Physician Fee Schedule (PFS) generated more attention than usual this year among practices that have considered or are already offering Remote Patient Monitoring (RPM) to their patients. CMS’s July 14 publication of the proposed rule, outlining revisions to payment policies and rates, was seen as particularly significant for RPM.
Key changes to RPM under the 2026 PFS include the introduction of a code for 2-15 days of data collection and another that allows
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The ICHRA Revolution. How Flexible Infrastructure Unlocks Sustainable Growth
Individual Coverage Health Reimbursement Arrangements (ICHRAs) are rapidly gaining traction as an alternative to traditional group plans. What began as a niche option for small employers is now reshaping the broader health insurance marketplace — and accelerating a fundamental shift toward Individual market enrollment.
As adoption grows, so do the operational demands. ICHRA doesn’t fit neatly into legacy group-based systems. It requires a decentralized, multi-stakeholder infrastructure:
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Is Professor AI The Next to Lead The Nursing Classroom?
For decades, educators have sought better ways to prepare students for a rapidly evolving clinical environment. Now, artificial intelligence (AI) is emerging as an important part of the roadmap. AI is playing into adaptive learning systems, virtual simulations and predictive analytics to personalize education in ways previously unimaginable.
However, this transformation won't happen in isolation. Of course, AI presents exciting opportunities to evolve the education landscape, but it also
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Why Value-Based Care Fails to Reward LTPAC Providers Today
The chorus of voices singing the praises of value-based care is growing ever louder. But in LTPAC, it still feels like the system’s asking providers to do more—with less—and faster than ever.
For the past 25 years, financial strategy in long-term and post-acute care has been tied to two things: occupancy and payer mix. Around 70% of residents are covered by Medicaid. The rest—split between Medicare fee-for-service, Medicare Advantage, and private pay—bring in higher rates, especially
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The Future is Hybrid: Why AI Must Coexist with Fax and Forms in Healthcare Workflows
Health technology headlines often sound futuristic—AI scribes that capture visits in real time, or voice-activated assistants guiding patients through their care. These innovations are real, and they’re being tested in hospitals and clinics today.
Yet the reality across much of healthcare looks very different: paper forms, fax machines, and manual data entry remain part of everyday life.
This isn’t a contradiction. It’s the reality of healthcare—an industry shaped as much by policy,
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The Future of Payment Integrity: Navigating Challenges, Embracing Opportunities
Payment integrity (PI) is an essential component of the healthcare ecosystem, ensuring that payers correctly process claims and prevent financial losses due to errors, fraud, or misinterpretations of contracts. In today’s environment, major healthcare payers face substantial financial challenges, which can lead to layoffs and increased scrutiny of how money flows through the system. The demand for highly advanced, balanced PI solutions has never been greater.
Getting PI right has never
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