What You Should Know:
- UnitedHealth Group revealed it is facing a Justice Department (DOJ) criminal and civil investigation into its Medicare billing practices, adding to a series of recent setbacks for the nation’s largest and most powerful private insurer.
- The company also announced it has launched a third-party review of its business policies and performance metrics, expected to be completed by the end of the third quarter. The announcement comes after a tumultuous period for
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Revenue Cycle Management | News, Analysis, Insights - HIT Consultant
Humana Accelerates Prior Authorization Reforms, Pledges to Cut Requirements and Expedite Approvals
What You Should Know:
- Humana Inc. announced accelerated efforts to approve care requests as quickly as possible and reduce the administrative burden for physicians associated with prior authorization.
- These actions aim to streamline and reduce prior authorization requirements while preserving the system of checks and balances that protects patient safety for high-cost, high-risk treatments.
Prior Authorization Reform
Humana is working to reduce the "red tape" on prior
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TechMatter Acquires DoctorPapers to Expand Healthcare Revenue Cycle Management Services
What You Should Know:
- TechMatter, a leading provider of enterprise healthcare and automation solutions, acquires DoctorPapers, a California-based medical billing and revenue cycle management (RCM) company. This strategic move reinforces TechMatter’s mission to deliver scalable, tech-driven healthcare operations to providers across the United States. Financial details of the acquisition were not disclosed.
- Founded in 2020, DoctorPapers has built a strong reputation for delivering
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Charta Health Secures $22M to Automate Medical Billing and Clinical Documentation with AI
What You Should Know:
- Charta Health, an AI-powered platform that automates and optimizes medical billing and clinical documentation workflows secures $22M in Series A funding round led by Bain Capital Ventures, with participation from Madrona, SV Angel, Refract Ventures, and South Park Commons.
- The U.S. healthcare system loses over $300 billion each year due to billing errors, undercoding, and preventable claim denials. This significant financial drain often stems from slow,
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PwC Report: US Medical Cost Trend to Remain Elevated at 8.5% in 2026
What You Should Know:
- The U.S. healthcare system is entering 2026 with medical cost trends reminiscent of 15 years ago, facing persistent inflationary forces and significant federal policy changes, according to a new report from PwC.
- The report, "Medical Cost Trend: Behind the Numbers 2026," projects the Group medical cost trend to remain at 8.5% in 2026 (the same level as 2025) and the Individual market trend at 7.5%. Pharmacy costs are a particular concern, projected 2.5
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Methodist Le Bonheur Selects Ensemble as Strategic RCM Partner
What You Should Know:
- Ensemble, a revenue cycle managed services partner for healthcare organizations, announced that Methodist Le Bonheur Healthcare (MLH) has selected it as its strategic revenue cycle management (RCM) partner.
- Ensemble will assume full responsibility for end-to-end revenue cycle operations across all six hospitals in the Memphis-based health system, bringing advanced technology, deep operational expertise, and a shared commitment to delivering exceptional
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ZeOmega Partners with Massachusetts Health Data Consortium to Launch Nation’s First Statewide FHIR-Based Prior Authorization System
What You Should Know:
- ZeOmega®, a population health and interoperability technology company announced it has been selected by the Massachusetts Health Data Consortium (MHDC), a nonprofit advancing health data sharing, to transform prior authorization and clinical data exchange across Massachusetts.
- The initiative creates the nation’s first statewide FHIR®-based system designed to streamline communication between payers and providers, reducing administrative burdens and
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What Are Healthcare’s Most Pressing Revenue Integrity Issues in The Remote-Work Era?
With more and more organizations merging for scale and sustainability, revenue cycle teams are being centralized, taking these critical personnel further away from physicians at the bedside. Remote teams are finding it harder than ever to collaborate with clinicians on critical functions.
Simultaneously, more revenue cycle functions are being automated as robotic process automation and generative AI evolves. With fewer administrative personnel in general — and even fewer
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Omega Healthcare Expands Microsoft Collaboration, Launches 20+ AI Solutions to Transform Revenue Cycle Management
What You Should Know:
- Omega Healthcare, a provider of technology-enabled Revenue Cycle Management (RCM) services, today announced an expanded collaboration with Microsoft.
- Through the integration of Microsoft Azure's cutting-edge AI models via Azure AI Foundry and the company's proprietary Omega Digital Platform (ODP), Omega Healthcare has launched more than 20 generative and agentic AI solutions designed to enhance healthcare organizations' revenue cycle operations and
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5 Trends Reshaping Radiology RCM in 2025: AI, Automation, and The Road Ahead
Artificial intelligence (AI) is transforming radiology practices through improved diagnostic accuracy, efficiency, and patient care. Just as it analyzes images for subtle patterns and anomalies, AI is emerging as an essential tool for streamlining billing, increasing efficiency, and maximizing collections.
CEOs, CFOs, practice managers, billing leaders, and practice owners must stay ahead of emerging trends to remain competitive, efficient, and profitable. Every radiology practice
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