The U.S. healthcare system is grappling with a surge in claim denials and prior authorization requirements, creating significant challenges for both providers and patients. To shed light on this pressing issue, we spoke with Oron Afek, CEO of Vim, a company that assists over 20,000 providers and 80% of the largest U.S. payers with prior authorizations.
In this interview, Oron Afek provides valuable insights into the challenges and potential solutions related to claim denials and prior
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Denials Management
SmarterDx Launches AI-Powered Appeals Solution to Fight Payer Denials
What You Should Know:
- SmarterDx, a provider of clinical AI for revenue integrity, has announced the launch of SmarterDenials, an innovative AI-driven solution designed to help hospitals fight unjust claim denials.
- With denials on the rise, causing operational disruptions and revenue loss for healthcare providers, SmarterDenials empowers hospitals to generate stronger clinical appeal letters and secure faster and more accurate reimbursements.
Addressing the Growing
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Claimable Launches AI-Powered Appeals Platform to Fight Unjust Healthcare Denials
What You Should Know:
- Claimable, a healthcare technology innovator, is taking on the pervasive issue of healthcare claim denials with the launch of its AI-powered appeals platform.
- This solution leverages advanced AI to analyze clinical research, policy details, appeals data, and patients' individual medical circumstances to generate and submit customized appeals in mere minutes.
Combating a Broken System
The U.S. healthcare system is plagued by an alarming rate of
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Claim Denials Surge as Healthcare Providers Struggle with Tech Adoption
What You Should Know:
- A new Experian Health study reveals a concerning trend in the healthcare industry: claim denials are on the rise, and healthcare providers are increasingly hesitant to embrace technology solutions that could alleviate this burden.
- The Experian Health 2024 State of Claims survey paints a stark picture of the challenges providers face in managing their revenue cycles.
The Growing Claim Denial Crisis
Compared to a similar study conducted in 2022,
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How AI Can Increase the Success of Clinical Denials Appeals
It’s a perfect storm of financial pressures facing healthcare provider organizations – from rising costs to labor shortages to constrained capacity – that stymies revenue growth. Growing challenges with payer payments only exacerbate these issues. According to a Kaufman Hall report, 73% of leaders surveyed said claims denials, which was the top revenue cycle issue in 2022, had increased in 2023.
The cost of denials is staggering. A recent data analysis revealed that providers spent nearly $20
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Availity Launches AI-Powered Claims Denial Prediction Tool
What You Should Know:
- Availity, a real-time health information network launches Predictive Editing, a revolutionary feature within its Availity Essentials Pro™ platform.
- The AI-powered tool developed in partnership with Anomaly Insights empowers healthcare providers to significantly reduce claim denials, leading to smoother revenue cycle management and improved financial performance.
The Problem: Costly Claim Denials
Denied claims are a major pain point for healthcare
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RapidClaims Emerges from Stealth with $3.1M to Tackle Healthcare Claim Denials with AI
What You Should Know:
- RapidClaims, a healthcare technology startup focused on automating medical coding and reducing claim denials, has officially exited stealth mode after securing a $3.1M seed funding round. The seed round was led by Together Fund, a $250 million global SaaS fund, with participation from Better Capital, Neon Fund, Peercheque, DeVC with angels and advisors coming from prominent US healthcare organizations including Oscar Benavidez (Executive Director, Mass General), Ankit
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How AI is Changing the Conversation Around Hospital Denials – and Improving Financial Implications in the Process
Of the many complexities within the healthcare industry, medical necessity determinations can be the most challenging – and pose one of the greatest barriers to efficient revenue cycle processes and appropriate reimbursement. Complex medical necessity policies that differ between payer, diagnosis, and presentation have muddled utilization review (UR) and revenue cycle processes for years, driving waste and friction between providers and payers that has only intensified since the pandemic.
In
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Denials Management Named Most Time-Consuming Task in RCM
What You Should Know:
A new HFMA survey commissioned by AKASA highlights the revenue cycle tasks requiring the most subject matter expertise, according to responses from over 550 CFOs and revenue cycle leaders at hospitals and health systems across the U.S.Denials management not only requires the most subject matter expertise, but it’s also the most time-consuming task within revenue cycle management (RCM) — followed by prior authorization and insurance
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Experian Health Launches AI-Driven Predictive Denials Management
What You Should Know:
- Experian Health launches a new AI-Powered solution, AI Advantage that will help providers recoup the billions in lost dollars due to insurance claim denials.
- These new solutions leverage AI and help healthcare providers prioritize their claims reimbursement process and decrease denials overall, saving time and money across the entire healthcare value chain and ultimately improving care and service for patient consumers.
AI Advantage
One of the top
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