What You Should Know
Oracle Health announced major new U.S. capabilities for the Oracle Health Clinical AI Agent, expanding its multi-agent architecture across ambulatory professional fee coding, clinician-controlled dictation, and EHR chart review.The professional fee coding capability analyzes visit conversations to suggest accurate charge codes directly within the orders workflow, speeding up charge capture and reducing downstream billing rework while keeping final submission approval with
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Revenue Cycle Management | News, Analysis, Insights - HIT Consultant
R1 to Acquire Humata Health, Advancing Phare OS with AI-Powered Prior Authorization Automation
What You Should Know
R1 entered into a definitive agreement to acquire Humata Health, an AI-powered prior authorization technology company, to embed agentic, touchless authorization capabilities into R1’s Phare Operating System (Phare OS).The transaction is expected to close by the end of the third quarter of 2026, with the Humata team joining R1’s R37 innovation lab to accelerate agentic AI engineering across the revenue cycle.Prior authorizations remain a top-three driver of hospital claim
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The Cheapest Money a Hospital Will Ever Make Is the Money It’s Already Owed
This is shaping up to be another challenging year for healthcare system finances. It is not exactly beach reading. But neither is missing payroll.
The 2026 Costs of Caring Report from the American Hospital Association (AHA) spells it out:
Hospital expenses rose by 7.5% in 2025.About 56% of hospital costs are tied to service lines where reimbursement falls short of (or is less than) the cost of delivering care, including behavioral health, obstetrics, infectious disease, and burns and
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Why Exception-Driven RCM Is the Only Sustainable Operating Model
Healthcare has spent years trying to optimize a revenue cycle operating model that no longer works. Every new wave of technology has promised to make work queues more efficient. Better analytics. Better automation. Now AI.
We've spent years asking, "How do we work every claim faster?" The better question is, "Why are people working so many of these claims at all?"
The problem isn't that revenue cycle teams can't keep up. The problem is that we've built operating models where people are
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Inovalon Research Identifies Preventable Drivers of Claim Denials and Prior Authorization Delays
What You Should Know
An Inovalon national survey of over 400 revenue cycle management (RCM) leaders by Inovalon reveals that healthcare's most costly billing problems begin before a claim is ever submitted.Front-end workflow breakdowns drive 78% of denied claims, led by insurance eligibility verification, patient registration, and prior authorization delays.Prior authorization remains heavily manual: 93% of provider organizations rely on phone, fax, or payer portals, with only 7% utilizing
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Cedar Launches Purpose-Built AI Agents for Patient Revenue Recovery
What You Should Know
Cedar officially announced the Kora Platform, evolving its single AI billing agent into an integrated suite of purpose-built, autonomous AI agents designed for healthcare revenue recovery.Built on a foundation of 1.5 billion+ patient interactions, $13.6 billion in processed payments, and 63 million+ patients served, Kora integrates directly into existing EHR, telephony, and contact center environments.The platform features Autonomous Inbound Voice, Autonomous Outbound
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M&A: EnableComp Acquires Helix Advisory to Advance Complex Revenue Recovery Platform
What You Should Know
Complex RCM leader EnableComp announced its acquisition of Cincinnati-based revenue recovery firm Helix Advisory.The acquisition expands EnableComp's Zero Balance Review capabilities, integrating underpayment recovery directly into the same platform used for complex claims and denials.Helix Advisory's technology adds three specific capabilities: detecting underpayments outside traditional rules-based audit logic, clinical signal detection to flag reimbursement
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XiFin and Notable Systems Form Strategic Alliance and Announce Series B Investment
What You Should Know
XiFin, Inc. and Notable Systems announced a multi-year strategic alliance to develop and embed purpose-built agentic AI capabilities across the XiFin Empower AI RCM ecosystem.As part of the multi-year alliance, XiFin made a strategic investment in Notable Systems during Notable's Series B financing round.The partnership targets complex billing domains—including diagnostics, outpatient laboratories, specialty pharmacies, and durable medical equipment (DME)—by automating
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M&A: Health Catalyst Closes $147M Sale of Vitalware to Med-Metrix
What You Should Know
Healthcare intelligence leader Health Catalyst, Inc. completed the sale of its mid-revenue cycle business, Vitalware, LLC, to Med-Metrix, LLC on July 31, 2026.The divestiture generated $147M in total cash consideration, subject to customary adjustments.Health Catalyst combined the net proceeds with cash on hand to fully repay and retire its credit facility, eliminating approximately $19M in annual GAAP interest expense.Capital and operational focus will pivot toward
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The Growing Disconnect Between Clinical Documentation and Reimbursement
Most documentation problems I have reviewed over the years were never really about documentation itself. They were workflow problems that showed up later as denials, CDI overruns, and revenue that quietly disappeared.
That is the honest truth the industry keeps avoiding. We keep buying tools to fix a problem that is not about tools. The gap between clinical documentation and reimbursement is not growing because technology is failing. It is growing because we keep ignoring how misaligned our
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