With more and more organizations merging for scale and sustainability, revenue cycle teams are being centralized, taking these critical personnel further away from physicians at the bedside. Remote teams are finding it harder than ever to collaborate with clinicians on critical functions.
Simultaneously, more revenue cycle functions are being automated as robotic process automation and generative AI evolves. With fewer administrative personnel in general — and even fewer
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Health IT & Digital Health-Opinion | Op-Eds | Guest Columns | Analysis, Insights - HIT Consultant
New Strategies Needed: No Surprises Act and the Challenges for Payors with Provider Data Inaccuracies
With more than 20 years of experience at a major health insurance company, I’ve seen firsthand how challenging provider data management can be. I’ve worked with teams reconciling files from delegated groups, fielded calls from frustrated providers, and navigated compliance pitfalls that can quickly become operational headaches. But the stakes have never been higher than they are now under the No Surprises Act (NSA).
For years, maintaining an accurate provider directory was considered a best
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Boost Medicare Star Ratings: A Strategic Game Plan for Health Plans
As they navigate complex times, health insurers have their eye on two important financial indicators. And both are moving in the wrong direction. Costs are on the rise while Medicare Star Ratings are on the decline.
Separate but related, the two trends converge on the same idea: health plans need to enable higher quality care at a lower price.
If it sounds like a Herculean feat, that’s because it is. But some health plans are making it happen.
While some of the cost pressures—for
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Blood Pressure Monitoring in Pregnancy Is a Window into Long-Term Health
New research continues to affirm what maternal health advocates have long known: pregnancy is a powerful window into long-term health. One of the most promising areas of study is blood pressure monitoring, which is proving to be not just essential for a healthy pregnancy, but a potential predictor of future cardiovascular disease — the leading cause of death in the United States.
For many women, pregnancy may be the first meaningful interaction with the healthcare system in
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Beyond Patient-Centric: The Rise of Evidence-Based, Content-Centric Care
he past decade has seen healthcare undergo a paradigm shift. Walking into a treatment room today, the dynamic with patients is fundamentally different from even a few years ago. No longer satisfied with passively receiving care, patients – in particular, younger generations like Gen Z – increasingly want a seat at the table. They want to be active, informed participants in all aspects of their health care. And the data backs this up. According to McKinsey, only 42% of Gen Z depend on doctors for
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Digital Lifelines: Fortifying Healthcare’s Cybersecurity Amid Budget Cuts
IT leaders in healthcare are no strangers to pressure. They are expected to safeguard sensitive patient data, maintain compliance, and ensure teams have the technology needed to support clinical operations amid shrinking budgets and rising cyber risks. Cybercriminals know this, and they’re exploiting it.
The U.S. remains the top targeted region for ransomware attacks against healthcare organizations. The wealth of sensitive data and life-or-death stakes make these organizations more likely
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Multimodal AI Will Power the Future of Remote Diagnostics and Virtual Hospitals
As a veteran of multiple healthcare startups, it’s hard not to become immune to claims of technological developments which will “revolutionize patient care”.
To be fair, revolutionary changes do exist. Telehealth for example, enabled by the combination of AI and cloud technology, has revolutionized the access patients have to robust diagnostic services. Yet, telehealth with its data fragmentation and current clinical diagnostic limitations, still has serious challenges
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Providers & Payers: Prepare Now for CMS Prior Authorization Final Rule
The new administration shed light on policy issues at the top of providers’ lists for 2025. While topics like physician burnout and Medicare payment reform were included, unsurprisingly, prior authorization remains at the forefront, as proven by entities like the American Medical Association, who represent more than 270K providers. Improvements in the prior authorization and interoperability space have been historically stalled due to lack of standard data and public reports, as technology
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Health Equity 2.0 – Bridging Health Equity Gaps with AI Agents
Despite decades of panels, pledges, and policy proposals, healthcare inequity remains a systemic issue in day-to-day experience of the American healthcare consumer. The data is overwhelming - patients in lower-income ZIP codes have worse healthcare outcomes, people of lower socio-economic tiers are more likely to suffer from preventable conditions. Access to timely, quality care is still a privilege. Equity in healthcare is different from the equity discussion that’s playing out right now in
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5 Trends Reshaping Radiology RCM in 2025: AI, Automation, and The Road Ahead
Artificial intelligence (AI) is transforming radiology practices through improved diagnostic accuracy, efficiency, and patient care. Just as it analyzes images for subtle patterns and anomalies, AI is emerging as an essential tool for streamlining billing, increasing efficiency, and maximizing collections.
CEOs, CFOs, practice managers, billing leaders, and practice owners must stay ahead of emerging trends to remain competitive, efficient, and profitable. Every radiology practice
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