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Health IT | News, Analysis, Insights - HIT Consultant

Denial Prevention AI: Ember Raises $4.3M to Cut Healthcare Denials by Over 57%

by Fred Pennic 11/19/2025 Leave a Comment

What You Should Know: - Ember, the AI-native solution for denial prevention secures $4.3M in seed funding round led by Nexus Venture Partners and Y Combinator. - Its platform uses deep knowledge of payer policies to cut denials by more than 57% and boost net collections by 25% for health systems. The Denial Crisis: Fueling Burnout and Financial Loss Healthcare providers nationwide face an intensifying crisis driven by claim delays and denials, which create significant anxiety for patients, frustration for doctors, and a massive drag on resources. The problem is growing exponentially: Public Concern: 73% of U.S. adults view delays and denials by insurers as a "major problem". Physician Burnout: 89% of physicians cite prior authorization as a contributor to burnout. Policy Complexity: Over 50% of billing codes are restricted to a single insurer, meaning providers must manage wildly different and ever-changing requirements for each payer. Ember’s AI-Native Solution: Preventing Denials Before They Happen Ember is designed to solve the problem at its root, recognizing that most denials are triggered by technicalities and the impossibility of human administrators keeping up with varied payer policies. Ember's platform gets to work the moment a provider signs off on treatment: Proactive Compliance: It assigns medical codes, pulls documentation, and ensures the claim complies with payer requirements before submission. Unwritten Rules: Ember analyzes trends and behaviors from across the country to identify unwritten rules and practices not found in any public database, which often mean the difference between approval and denial. Superior Accuracy: The AI consistently delivers better accuracy than certified human coders and general-purpose AI. The AI Appeals Engine and Rapid Value For claims that are denied, Ember’s unique AI Appeals Engine drastically reduces the labor-intensive task of appealing. Ember’s AI agents scour the declined request and patient records, identify the best clinical evidence, and draft a comprehensive appeal in minutes. The platform is built for rapid deployment and integrates seamlessly with all major EHR, PMS, and payer systems (including Epic, Oracle Cerner, and athenahealth). Providers begin seeing value immediately, with proven results: Denial Reduction: More than 57% reduction in denials. Net Collection Rate: 25% increase in net collection rate. Admin Time Savings: Providers spend 83% less time on admin.

What You Should Know:  - Ember, the AI-native solution for denial prevention secures $4.3M in seed funding round led by Nexus Venture Partners and Y Combinator.  - Its platform uses deep knowledge of payer policies to cut denials by more than 57% and boost net collections by 25% for health systems. The Denial Crisis: Fueling Burnout and Financial Loss Healthcare providers nationwide face an intensifying crisis driven by claim delays and denials, which create significant
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Oracle Health’s AI-Powered EHR Achieves ONC Certification & EPCS Compliance

by Jasmine Pennic 11/19/2025 Leave a Comment

Oracle Health to Launch AI-Powered Solutions for Payers and Providers

What You Should Know:  - Oracle Health has announced a major breakthrough with its next-generation Electronic Health Record (EHR), which is now certified and available for adoption by ambulatory customers in the U.S.. - The new EHR earned the ONC Health IT certification from the Office of the National Coordinator (ONC) and successfully met the DEA’s Electronic Prescriptions for Controlled Substances (EPCS) compliance requirements. These certifications confirm the platform meets
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Why Retrospective Audits Are No Longer Sustainable Against Rising Payer Scrutiny

by Ritesh Ramesh, CEO of MDaudit 11/19/2025 Leave a Comment

Why Retrospective Audits Are No Longer Sustainable Against Rising Payer Scrutiny

In late 2023, a multi-hospital health system in the Southeast saw a sudden spike in payer requests for documentation. The compliance team had been running routine retrospective audits, but the pace of incoming denials and takebacks began to outstrip their ability to respond. Within six months, the organization reported more than $11 million in at-risk revenue and a doubling of external audit activity.   Despite their best efforts, the system was playing defense.  This story
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Humana and Epic Launch Coverage Finder to Deliver Digital-First Medicare Advantage Check-In

by Fred Pennic 11/18/2025 Leave a Comment

Humana Partners with Sunrise to Expand Digital Sleep Apnea Diagnostics

What You Should Know:  - Humana today announced the broad activation of Epic’s Coverage Finder and Digital Insurance Card Exchange for its Medicare Advantage members.  - The partnership streamlines check-in and ensures automated, paperless insurance verification for over 800,000 members at hundreds of health systems today announced the broad activation of Epic’s Coverage Finder and Digital Insurance Card Exchange capabilities for its Medicare Advantage membership – marking a
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Why Ambient AI is Now a Deciding Factor in Clinician Recruitment

by Dr. David Atashroo, Chief Medical Officer, Perioperative, at Qventus 11/18/2025 Leave a Comment

Why Ambient AI is Now a Deciding Factor in Clinician Recruitment

Health systems nationwide are grappling with a critical and intensifying challenge: how to attract and retain the next generation of clinical talent.  With the physician shortage not showing signs of slowing down, organizations are in dire need of new strategies to retain the talent they’ve cultivated, while also appealing to younger clinicians who will be essential to meeting the rising demand for care.  Unlike many of their more seasoned counterparts who may be comfortable with
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NVIDIA, Sheba, and Mount Sinai Partner to Decode 98% of Human Genome with LLM

by Fred Pennic 11/18/2025 Leave a Comment

NVIDIA, Sheba, and Mount Sinai Partner to Decode 98% of Human Genome with LLM

What You Should Know: - ARC Innovation at Sheba Medical Center and the Icahn School of Medicine at Mount Sinai (part of the Mount Sinai Health System) have announced a major three-year collaboration with NVIDIA. The initiative focuses on applying Large Language Model (LLM) technology to genomic research. - The primary objective is to pioneer the decoding of the majority (98%) of the human genome that remains poorly understood. By deciphering this area—once labeled "junk DNA"—researchers
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Thrivory Raises $25M Credit and $3.5M Equity to Eliminate Healthcare Reimbursement Delays with AI

by Fred Pennic 11/18/2025 Leave a Comment

Thrivory Raises $25M Credit and $3.5M Equity to Eliminate Healthcare Reimbursement Delays with AI

What You Should Know: - Thrivory, the AI-powered healthcare fintech company, has secured $3.5M in equity led by Redesign Health and up to $25M in credit from Trinity Capital. - The funding supports the scale of its ThriveNow API, which embeds instant, non-recourse claims payments directly into EHR and practice management systems. Solving Healthcare’s Biggest Financial Barrier: Slow Reimbursement Thrivory, a healthcare AI company founded in 2023, is tackling the slow and unpredictable
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TytoCare Integrates With Teladoc Health to Augment Virtual Primary and Urgent Care

by Jasmine Pennic 11/18/2025 Leave a Comment

TytoCare Integrates With Teladoc Health to Augment Virtual Primary and Urgent Care

What You Should Know: - TytoCare, the company leading in-home, clinical-grade physical exams, today announced a strategic collaboration with Teladoc Health. The collaboration will integrate TytoCare’s Home Smart Clinic with Teladoc Health’s 24/7 Care and Primary360 primary care programs. - This integration, set to begin rolling out to select customers during 2026, aims to elevate home-based care by providing Teladoc Health care teams with essential diagnostic insights collected directly at
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Why AI in Healthcare ERP is the Biggest Opportunity for Cost Reduction

by Juanita Schoen, Sr. Engagement Manager at Columbus 11/18/2025 Leave a Comment

Why AI in Healthcare ERP is the Biggest Opportunity for Cost Reduction

When most healthcare executives hear about artificial intelligence, they think of drug discovery or clinical trials, but the bigger opportunity is happening behind the scenes. Enterprise resource planning (ERP) systems are the backbone of finance, supply chain and compliance, and they’re beginning to leverage AI to transform how healthcare companies understand and act on their data. By 2025, most major ERP platforms will ship with built-in AI features, but the question is how advanced and
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HIT Professional Services Outlook 2025: CIOs Prioritize Investment in AI, Cybersecurity, and EHR Optimization

by Fred Pennic 11/17/2025 Leave a Comment

HIT Professional Services Outlook 2025: CIOs Prioritize Investment in AI, Cybersecurity, and EHR Optimization

What You Should Know:  - The 2025 healthcare landscape is marked by significant uncertainty due to evolving reimbursement models and shifting federal policies. Margin pressures are intensifying across the industry. However, healthcare organizations are responding by intensifying, not cutting, investments in Health Information Technology (HIT) professional services. - A survey of 105 CIOs by KLAS Research revealed that the vast majority plan to maintain or increase spending on
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