In late 2023, a multi-hospital health system in the Southeast saw a sudden spike in payer requests for documentation. The compliance team had been running routine retrospective audits, but the pace of incoming denials and takebacks began to outstrip their ability to respond. Within six months, the organization reported more than $11 million in at-risk revenue and a doubling of external audit activity.
Despite their best efforts, the system was playing defense.
This story
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Revenue Cycle Management | News, Analysis, Insights - HIT Consultant
Thrivory Raises $25M Credit and $3.5M Equity to Eliminate Healthcare Reimbursement Delays with AI
What You Should Know:
- Thrivory, the AI-powered healthcare fintech company, has secured $3.5M in equity led by Redesign Health and up to $25M in credit from Trinity Capital.
- The funding supports the scale of its ThriveNow API, which embeds instant, non-recourse claims payments directly into EHR and practice management systems.
Solving Healthcare’s Biggest Financial Barrier: Slow Reimbursement
Thrivory, a healthcare AI company founded in 2023, is tackling the slow and unpredictable
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MedEvolve Acquired by Emergence: Accelerating AI-Powered Revenue Cycle Automation
What You Should Know:
- MedEvolve, Inc., a pioneer in AI-powered revenue cycle automation and analytics, today announced its acquisition by Emergence, an enterprise backed by The Pritzker Organization. Financial details of the acquisition were not disclosed.
- The strategic transaction combines MedEvolve’s proprietary Effective Intelligence® platform—which integrates workflow automation, analytics, benchmarks, and generative AI—with Emergence’s long-term orientation and deep
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AI Prior Authorization: Humata Health Partners with CMS on WISeR Model to Modernize Medicare
What You Should Know:
- Humata Health, a provider of AI-powered prior authorization technology, has been selected by the Centers for Medicare & Medicaid Services (CMS) as a key partner for its new initiative: the Wasteful and Inappropriate Service Reduction (WISeR) model.
- CMS, the single largest payer for healthcare in the U.S., has chosen Humata Health to deploy its proprietary technology in a program that directly addresses the staggering variability of care and significant
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Demystifying Prepay Coordination of Benefits: A Crucial Component of Payment Integrity
Coordination of benefits (COB) is a key component of any effective payment integrity program. But determining primacy for members with multiple plans and ensuring claims aren’t overpaid can be a complicated process. Whether it’s verifying employment status or sifting through complicated claims, COB takes significant time for peak accuracy. And while health plans focus on the intricacies of an effective COB strategy, many overlook the possibilities that a comprehensive prepay COB solution can
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Datavant and athenahealth Partner to Automate Medical Record Release at Scale
What You Should Know:
- Datavant, a data collaboration platform, and athenahealth, Inc., a provider of network-enabled software and services announced an anticipated partnership aimed at transforming the historically manual and fragmented process of medical record requests and releases.
- By bringing together athenahealth’s market-leading EHR platform with Datavant’s expertise in health data exchange, the companies plan to build a modern, comprehensive infrastructure for data
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The $168B Answer: How AI Can Tame Healthcare’s Untamed Administrative Beast
A quick google (or generative AI) search will pour hundreds of statistics about the dire state of healthcare costs plaguing our nation. Whether it’s the fact that we spend almost 5x as much as neighboring Canada per capita on healthcare administrative costs or that it means every 4th dollar spent is wasted, there are numerous scary statistics we have grown used to reading.
It certainly wasn’t meant to be.
How did a system designed to heal become so broken and smeared in complexity
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Microsoft Unveils Expanded Dragon Copilot: AI Transformation for Nursing and Revenue Cycle
What You Should Know:
- Microsoft unveiled significant AI innovations for its leading clinical assistant, Dragon Copilot, leveraging ambient and generative technologies to enhance the patient journey, reduce workflow burden, and strengthen the financial integrity of healthcare provider organizations.
- The advancements include the industry’s first generally available commercial ambient experience tailored for nursing workflows and new extensibility capabilities that allow
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R1 to Acquire Phare Health: Unifying AI-Native Coding and Clinical Documentation Improvement
What You Should Know:
- R1, a provider of healthcare revenue management automation, today announced an agreement to acquire Phare Health, a technology company specializing in AI-native solutions for inpatient coding and clinical documentation improvement (CDI).
- The acquisition is a significant step in R1’s strategy to comprehensively automate the revenue cycle and move closer to real-time adjudication of medical claims.
Unifying Clinical Documentation and Financial
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Cleveland Clinic Deploys GenAI for Coding and CDI Across Enterprise Powered by AKASA
What You Should Know:
- Cleveland Clinic, one of the top academic medical centers in the U.S., has significantly expanded its partnership with AKASA, a leader in healthcare AI, to deploy an advanced Clinical Documentation Integrity (CDI) solution across all of its U.S. locations.
- The enterprise deployment follows a successful pilot and the system-wide adoption of AKASA’s AI coding tool, solidifying Cleveland Clinic’s position as a pioneer in applying generative AI (GenAI) to
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