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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Revenue Cycle Management | News, Analysis, Insights - HIT Consultant
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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Solventum Announces Intent to Separate Health Information Systems Business
What You Should Know
Solventum announced its intent to separate its Health Information Systems (HIS) business to sharpen focus as a pure-play MedTech provider centered on MedSurg and Dental Solutions.The Health Information Systems division generates $1.4B in annual sales, is deployed across 30+ countries, serves over 75% of U.S. hospitals, and processes roughly 660 million clinical documents monthly.Management operates within a ~$10 billion addressable market growing at 5–6% annually,
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AMS Solutions Releases 2026 Benchmark Report on The State of Medical Billing
What You Should Know
Physician-founded revenue cycle vendor AMS Solutions published its State of Medical Billing 2026 benchmark report, detailing a rise in industry-wide claim denial rates to 9% (up from 7.5% in 2023).Increased Medicare Advantage penetration and automated machine-learning claim reviews by commercial payers are driving higher denial rates, extended days in accounts receivable (averaging 42 days, up from 38), and stricter documentation requirements.Neurology exhibits the
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Procode Secures $10M to Scale AI-Powered Surgical Revenue Cycle Management
What You Should Know
AI-powered medical billing firm Procode Inc. announced a $10M Series A funding round led by Health Velocity Capital, bringing total venture funding to $14M.Funds two upcoming acquisitions of private practice billing agencies, mirroring its rollout following the acquisition of The Auctus Group (serving over 350 plastic surgery and dermatology providers).Combines Procode (automated CPT/ICD coding copilot), Procollect (billing team OS for AR acceleration), and the Auctus
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AdvancedMD Expands Waystar-Powered Revenue Cycle Offerings for Independent Practices
What You Should Know
Independent practice software leader AdvancedMD has expanded its revenue cycle management (RCM) suite with new Waystar-powered automation and AI capabilities.The launch directly addresses widespread provider friction—where 85% of medical groups rate payers poorly on reimbursement issues, and nearly 30% report worsening patient balance collections year-over-year.Key capabilities now live in the AdvancedMD portal include Coverage Detection (finding hidden billable
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