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Revenue Cycle Management | News, Analysis, Insights - HIT Consultant

Prior Authorization Technology Is the Weakest Link in the GLP-1 Revolution

by Dr. Quoc N. Dang, DO, 06/17/2026 Leave a Comment

Prior Authorization Technology Is the Weakest Link in the GLP-1 Revolution

The clinical case for GLP-1 receptor agonists in obesity management is no longer a debate. Randomized controlled trials have demonstrated sustained weight reduction of 15 to 22 percent of body weight, meaningful improvements in cardiovascular outcomes, and reductions in obesity related comorbidities including type 2 diabetes and sleep apnea. The American Association of Clinical Endocrinology, the American Gastroenterological Association, and major cardiology societies have all updated their
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M&A: Med-Metrix Acquires CanAide to Automate Patient Access

by Fred Pennic 06/11/2026 Leave a Comment

Med-Metrix Acquires CanAide to Automate Patient Access

What You Should Know Technology-enabled revenue cycle management (RCM) platform Med-Metrix, LLC has signed a definitive agreement to acquire front-end automation specialist CanAide, Inc. from HCAP Partners.This marks Med-Metrix's second major acquisition agreement within a single week, arriving immediately on the heels of its $147 million acquisition of Health Catalyst’s mid-revenue cycle software business, Vitalware.Backed by private equity heavyweights Harvest Partners and A&M Capital
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AGS Health Launches InnovationWorks™ Center of Excellence to Scale Revenue Cycle AI

by Fred Pennic 06/09/2026 Leave a Comment

AGS Health Launches InnovationWorks™ Center of Excellence to Scale Revenue Cycle AI

What You Should Know Tech-enabled revenue cycle management (RCM) pioneer AGS Health has launched AGS Health InnovationWorks™, a dedicated center of excellence purpose-built to deliver pragmatic, ROI-driven RCM AI solutions.The center addresses severe operational barriers by engineering AI tools to adapt natively to a health system's specific payer mix, localized workflows, and rigid compliance mandates.Backed by global tech and investment leaders including Blackstone and Amazon Web Services
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Surescripts Expands Prior Authorization Automation: Slashing Prescription Approval Times as New CMS Interoperability Rules Loom

by Fred Pennic 05/20/2026 Leave a Comment

What You Should Know Surescripts has expanded its Prior Authorization Automation solution, increasing the number of enabled clinicians by 50% since December 2025 to reach 68,000 prescribers across 42 major health systems.Automated prior authorization systems achieved a median approval time of just 18 seconds when clinical determination criteria were met, bypassing traditional manual forms, faxes, and telephone calls.Real-Time Prescription Benefit tools saved patients $19.7 million from
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Commure Secures $70M to Drive 85% Autonomous Revenue Cycle Execution

by Fred Pennic 05/19/2026 Leave a Comment

Commure Secures $70M to Drive 85% Autonomous Revenue Cycle Execution

What You Should Know Commure, an AI platform for healthcare operations, secured a $70M financing round at a $7 billion post-money valuation led by General Catalyst, with participation from Sequoia Capital, Morgan Stanley, and Kirkland & Ellis.Tackling the $1 Trillion Problem: The company’s agentic AI infrastructure targets administrative waste—a sector that consumes an estimated $1 trillion annually in the U.S. alone.Proven Operational Automation: Commure’s end-to-end revenue cycle
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The $262B “Acceptance”: Why It’s Time to Stop Treating Denials as an Unavoidable Cost

by Dr. Wael Khouli, MD, MBA Co-Founder Chief Medical Officer, Authsnap 05/12/2026 Leave a Comment

The $262B "Acceptance": Why It’s Time to Stop Treating Denials as an Unavoidable Cost

I want to be direct about something: the denial problem in U.S. healthcare is not complicated to understand. It is complicated to fix, but the basic dynamic is straightforward. Hospitals deliver medically appropriate care, submit claims, and then watch a meaningful portion of those claims get denied. Most of those denials are never challenged. Revenue disappears. And somewhere along the way, we collectively decided this was just how things work. It isn’t. And we need to stop treating it like
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Transforming Medical Coding Operations Through Hybrid Intelligence Design

by Katy Morgan, General Manager - Automation, AGS Health 05/11/2026 Leave a Comment

Transforming Medical Coding Operations Through Hybrid Intelligence Design

Healthcare revenue cycle management is bending under the strain of evolving payer policies, complex documentation, and higher demands for accuracy and cost control. Exacerbating these challenges are rising coding assignment volumes, which are forcing HIM departments to address continued workforce shortages. These problems are interconnected and systemic. They cannot be solved by simply adding staff or deploying standalone automation tools. Instead, a more structured approach is emerging:
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Carlyle Acquires Knack RCM and EqualizeRCM to Build Global AI-Native Healthcare RCM Platform

by Fred Pennic 05/06/2026 Leave a Comment

Carlyle Acquires Knack RCM and EqualizeRCM to Build Global AI-Native Healthcare RCM Platform

What You Should Know Carlyle  has acquired a majority stake in Knack RCM and EqualizeRCM, merging them to create a global, multi-specialty, AI-native revenue cycle management (RCM) platform.The combined platform targets high-complexity segments, including rural hospitals, behavioral health, anesthesia, and durable medical equipment (DME).EqualizeRCM contributes proprietary AI tools like Bill Smart for denial prediction and an AI-native platform built on large language models (LLMs) and
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Fathom Secures Strategic Investment from CVS Health Ventures to Scale Autonomous Medical Coding

by Fred Pennic 05/06/2026 Leave a Comment

Fathom Receives Strategic Investment from CVS Health Ventures for Autonomous Medical Coding

What You Should Know Fathom, a leader in autonomous medical coding, has announced a strategic investment from CVS Health Ventures.The funding follows a period where revenue cycle management (RCM) has become the top priority for health IT investment, according to a 2025 Bain & Company/KLAS report.Fathom’s platform achieves 90%+ automation rates across multiple specialties, providing an alternative to slow, department-by-department AI rollouts.The company was recognized as the #1 solution
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RevSpring Report: 50% of Consumers Cut Back on Care Due to Financial Confusion and Cost

by Fred Pennic 05/05/2026 Leave a Comment

RevSpring Report: 50% of Consumers Cut Back on Care Due to Financial Confusion and Cost

What You Should Know RevSpring has released a national survey of 2,024 U.S. adults revealing that 94% of consumers agree healthcare needs to be made easier to navigate.Friction begins at the point of entry: 38% of consumers struggle to find an in-network provider.Financial uncertainty is a primary driver of disengagement, with 79% of patients reporting they have been surprised by the price of a medical bill.50% of respondents admitted to cutting back on medical care due to cost and confusion
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