Forward-thinking hospitals have long recognized clinical documentation integrity (CDI) and utilization management (UM) as priorities for a successful revenue cycle. The current economic climate only underscores their importance. The latest performance trends data from Strata Decision Technology noted that, while operating margins remain stable, payment volumes experienced a shortfall of nearly 18% in Q1 of 2024.
Now is the time for hospitals to explore how to further automate and
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Future-Ready: 10 Best Practices to Improve Prepay Claims Editing
In the fast-evolving and intricate landscape of payment integrity, the value of prepay editing is paramount. As powerful AI and advanced analytics are being applied earlier in the claim adjudication process, the importance of next-generation claim editing capabilities will separate health plan leaders from laggards.
If you’re equating claims editing with medical savings alone—you’re missing the boat and the opportunity. Because forward-thinking payment integrity and claims operations leaders
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Cybersecurity: Building a Resilient Healthcare Practice in the Face of Cyber Threats
A healthy patient-provider relationship is the foundation for delivering quality healthcare, yet increasingly occurring cyberattacks have negatively impacted patient health outcomes, data security, and care operations. With the recent cybersecurity breaches causing disruptions to operations and workflows that require a shift to manual and paper-based processes, providers must take all necessary technical steps to protect their patients, staff, and practice reputation from potential
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Alarming Rise of AI Voice Deepfakes: Waging War on Healthcare
Imagine you’re an IT professional for a large health system. A resident physician calls and says he must urgently send in a patient script, but he’s locked out of the system and needs a password or account reset. You recognize his voice. He provides his ID number and other credentials for verification. You successfully restored his access so he can log in – only, it wasn’t the doctor that you just spoke to. It was a cybercriminal.
Increasingly, threat actors are using social
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Remove the Ghosts from Haunted Provider Directories: 5 Things Payers Should Know
Payers place many resources—including time, personnel, and money—into maintaining provider networks for their plans and members. What is the intended goal after negotiating and contracting with networks? An accurate and comprehensive provider directory containing in-network clinicians and specialists that members can effectively use to “find a doctor” when they need care.
In reality, though, this is often an elusive goal. Members frequently find themselves haunted by ‘ghost
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Cyberattacks: A Recipe for Nurse Burnout and Compromised Patient Care
Nurses, the backbone of the medical field, have been facing a critical threat: burnout. A recent survey by the National Council of State Boards of Nursing found that nurses are under immense strain due to high workloads and stress, with a significant portion of nurses (between 45% and 56%) feeling emotionally drained, exhausted, and burned out regularly. A worrying 29% of nurses reported feeling like they're at their wits’ end several times a week or even daily. Characterized by emotional
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7 Strategies to Modernize The Healthcare Payment Ecosystem
Submitting and paying claims is the financial underpinning of the U.S. healthcare system, a system plagued with inefficiencies that create disconnects between health plans and health systems. As a result, revenue cycles and claims systems are clogged, the patient and member experience is disrupted, care quality is suffering, and innovations in care delivery are constrained.
The solution? Modernization.
Modernizing the healthcare ecosystem reduces wasteful administrative
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Responsible AI in Medicine for Underserved Populations
Artificial intelligence (AI) is making a tangible difference in healthcare today. It's not about science fiction or flashy gimmicks. It’s not about deep fakes or plagiarized term papers. AI is being responsibly used to prevent medical errors, enhance clinical decision-making, expand access to care, and lower costs. While there's certainly overenthusiasm and misleading claims about AI, we can't ignore the many instances where it's making healthcare more efficient, effective, and
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How Virtual Primary Care Can Enrich Your Practice
The COVID-19 pandemic made the word “virtual” a part of our everyday lexicon. Many services that were previously done in person—even schools—quickly made the transition to being virtual. Today, our world is forever changed as many services that once were only in-person continue to be virtual due to convenience, accessibility, and technological advancements that enable everything online.
Primary care has also benefited from virtualization of services. According to a study published in
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AI-Assisted Diagnostic’s Intersection with Risk Assessment: The Future of Medical Device Technology
From predictive analytics to personalized treatment plans, we’ve probably all heard about AI's potential to revolutionize medical diagnostics and treatment. As discussed in a recent NIH study, “more recently, state-of-the-art computer algorithms have achieved accuracies which are at par with human experts in the field of medical sciences.”
However, as AI algorithms increasingly integrate into medical devices and become more influential in diagnoses, ensuring the safety of the patients they
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