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
Read More
Health IT & Digital Health-Opinion | Op-Eds | Guest Columns | Analysis, Insights - HIT Consultant
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
Read More
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
Read More
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
Read More
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
Read More
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,
Read More
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
Read More
Why Incremental Change is Killing Healthcare Transformation
Fifteen years ago, I made a conscious decision to enter the healthcare sector. At 34, I had options, but I wanted a career that would challenge me intellectually—so much so that I once told people I wanted my “brain to hurt.” I wasn’t naïve about the industry’s complexities, but I didn’t anticipate how much it would also hurt my heart.
A decade and a half later, after working across multiple roles in healthcare, I can confidently say the industry met my wish for intellectual challenge. What I
Read More
How E-Prescribing Improves Opioid Safety and PDMP Compliance in Healthcare
According to recent CDC data, opioids remain the driving force behind the vast majority of U.S. drug overdose deaths. While prescription rates have declined over the past several years, opioid-related overdoses have actually risen again since 2024, underscoring that the crisis has not eased, but shifted. Today’s challenge isn’t just preventing overprescribing; it’s navigating a more complex risk environment where illicit drugs, prescription misuse, and patient access needs intersect.
How
Read More
HR Strategies for Engaging the ‘Deskless’ Healthcare Workforce
The average healthcare worker’s day is a whirlwind of patient care, quick decisions, and teamwork, rarely with a moment to sit, let alone check emails or attend a meeting. While office-based colleagues catch up on company news over coffee, front-line workers are running from room to room, often the last to hear about policy changes or organizational updates.
This is the reality for millions of frontline healthcare workers. Their dedication keeps hospitals running and patients
Read More
