What You Should Know
- Abridge, the leader in clinical conversational AI, and Availity, the nation’s largest health information network, have launched a first-of-its-kind collaboration to automate prior authorization in real-time.
- By embedding Availity’s FHIR-native Intelligent Utilization Management solution into Abridge’s Contextual Reasoning Engine, the partnership aims to provide clinicians with visibility into coverage requirements and enable payer determinations during the
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Revenue Cycle Management | News, Analysis, Insights - HIT Consultant
Penguin Ai Launches Snowflake Native App to Automate HCC Risk Adjustment
What You Should Know
- Penguin Ai has announced the launch of its Hierarchical Condition Category (HCC) Coding & Risk Adjustment solution as a Snowflake Native App.
- By bringing its risk-adjustment intelligence directly into a customer’s Snowflake environment, Penguin Ai enables Medicare Advantage (MA) plans and risk-bearing providers to automate diagnosis extraction and improve Risk-Adjustment Factor (RAF) accuracy without moving or exposing sensitive patient data.
The "Data
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The 40% Difference: Why AI Must Anchor Your RCM Modernization Strategy in 2026
The Crisis Facing Healthcare Financial Leaders
Healthcare financial leaders are navigating an environment of unprecedented complexity. Your organization is caught between escalating operational costs and a relentless denial rate fueled by increasingly sophisticated payer tactics. The truth is, if your Revenue Cycle Management (RCM) is reliant on manual, legacy systems, you are accepting a permanent, self-inflicted fiscal vulnerability.
Industry data confirms this exposure: upwards of 10%
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Denial Management: Closing Gaps and Reducing Revenue Leakage
Revenue leakage on the front end and mid-cycle is an ongoing challenge for hospitals and health systems. Rather than taking a reactive approach to the problem, proactively collaborating among teams prior to admission helps providers avoid playing the blame game when their claims are denied after the fact.
By focusing on reducing the number of denials before a claim is submitted, rather than trying to eliminate denials after the fact, revenue cycle managers can save time and energy. Today’s AI
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From Confusion to Collections: How Unclear Billing Fuels the Medical Debt Crisis
Medical debt remains a significant burden for patients nationwide, with U.S. residents collectively owing an estimated $220 billion. Medical visits already bring emotional and financial stress, and confusing bills only make matters worse. When patients receive statements that they don’t understand, or multiple, fragmented bills, they’re left frustrated, less likely to pay on time, and are at greater risk of accumulating medical debt.
While the July 2025 ruling striking down the Consumer
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Beyond the Margin Squeeze: How Specialty Providers Use RCM Automation to Combat Rising Costs
Despite a recent uptick in margins, providers continue to face significant pressure on their revenue cycles as a result of potential reimbursement cuts, workforce recruitment challenges, and higher costs.
Providers in 2024 reported operating margins of 1.2%, up from -0.5% the prior year, according to a report from Fitch. Nonetheless, margins remain “well below” pre-pandemic levels, and looming federal cuts to Medicaid funding could be devastating for some providers.
Federal
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Kaufman Hall Report: Rising Non-Labor Costs and Payer Denials Squeeze Hospital Margins in 2025
What You Should Know:
- According to Kaufman Hall’s 2025 Health System Performance Outlook, hospitals are facing a "financial trifecta" of rising non-labor expenses, workforce instability, and aggressive payer reimbursement pressures.
- Nearly 60% of health systems reported non-labor cost increases of up to 10%, driven by inflation and tariffs, while 44% cited high claim denial rates as a top challenge. As bad debt rises and staffing levels tighten, the report urges leaders to
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Transparency Trap: Why Commercial Negotiated Hospital Rates Are Up to 32% Higher Than Cash Prices
What You Should Know:
- New analysis of Texas hospital price data reveals a transparency paradox: discounted cash prices for common services are often significantly lower than the rates hospitals negotiated with commercial insurers, according to a new research study from Trilliant Health.
- For diagnostic colonoscopies, the median cash price was 32% below the median negotiated rate. This disconnect means that employees on high-deductible health plans (HDHPs) and the employers who
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Commure Autonomous Coding Scales to 200+ Sites with OBHG: Clinicians Reduce Charge Time by 83%
What You Should Know:
- Commure, a healthcare technology company, and Ob Hospitalist Group (OBHG), the nation's largest provider of OB/GYNs, have formed a strategic partnership to deploy Commure’s Autonomous Coding solution across nearly 2,000 clinicians and over 200 care sites.
- Early results are compelling: within three months, clinicians reduced the time spent entering charges by an impressive 83%, with AI now coding over 85% of all charges. This deployment strengthens
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Why Faster Prior Authorizations Won’t Fix Healthcare’s Real Issues
Few phrases raise blood pressure among doctors and patients like “prior authorization.” Ask any clinician and you’ll hear the same story: delayed treatments, endless back-and-forth, and vulnerable individuals left waiting while paperwork wins the day.
For providers, prior authorizations are a constant drain of time and energy. For patients, they can mean worsening conditions, missed windows for effective treatment, or even care that never arrives at all. And for payers, prior
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