Interoperability in the U.S. healthcare system has been an ongoing challenge. While there are several industry initiatives that are going to advance the industry and make incremental progress toward interoperability, there remain several gaps that are unaddressed. Interoperability is a much broader concept that encompasses more than protocols, APIs, and limited networks. It’s about more than exchanging data through one-to-one connections between a provider, payer, or vendor. True
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Revenue Cycle Management | News, Analysis, Insights - HIT Consultant
Ambience Healthcare Launches Automated AI Medical Scribe Platform
What You Should Know: - Ambience Healthcare, an AI company developing technology to supercharge healthcare providers launches its fully automated AI medical scribe, Ambience AutoScribe. - Already in use by provider organizations across North America, AutoScribe is revolutionizing the way healthcare providers document patient visits. How AutoScribe Works AutoScribe comprehensively captures the nuances of each patient story, without the need for a virtual or in-person human scribe.
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AGS Acquires Offshore Patient Access BPO Unit from Availity
What You Should Know: - AGS Health, a provider for tech-enabled revenue cycle management (RCM) solutions announces the acquisition of the India-based patient access outsourcing business unit of the Florida-based healthcare technology company Availity. - With more than half of U.S. hospitals anticipating a year of negative margins, achieving full and accurate reimbursement for services has never been more critical. With this expansion, AGS Health is positioned to provide faster, more
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Experian Health Launches AI-Driven Predictive Denials Management
What You Should Know: - Experian Health launches a new AI-Powered solution, AI Advantage that will help providers recoup the billions in lost dollars due to insurance claim denials. - These new solutions leverage AI and help healthcare providers prioritize their claims reimbursement process and decrease denials overall, saving time and money across the entire healthcare value chain and ultimately improving care and service for patient consumers. AI Advantage One of the top
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Why It’s Time for Intelligent Prior Authorization
The Centers for Medicare & Medicaid Services (CMS) recently proposed a new rule to advance interoperability and improve the prior authorization (PA) process for Medicare and Medicaid patients. Specifically, the rule stipulates that health plans adopt electronic prior authorization processes, adhere to shorter turnaround times, clearly communicate denial reasons, publish key metrics annually, and implement the Fast Healthcare Interoperability Resources (FHIR) Application Programming Interface
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KLAS Report Reveals Key Challenges from Provider Organizations
What You Should Know: - In September 2022, KLAS hosted the sixth annual Digital Health Investment Symposium (DHIS). Executives from healthcare provider organizations, HIT companies, investors, and innovators came together to collaborate on important developments in healthcare technology. - Drawing on insights from a pre-summit survey as well as insights shared at the summit in small-group discussions, KLAS published a white paper highlighting core challenges identified by summit
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5 Must-Have Features for AI Platforms in RCM
A healthy, stable revenue cycle is crucial to every healthcare organization’s success. However, managing the revenue cycle takes experienced coders, complete documentation, and timely resolution of denials. Administrative processes account for about 30% of U.S. healthcare costs, which means that all areas of a patient encounter, from check-in to billing and claims, are potential targets to obtain greater efficiency. In the past 20 years or so, computer-assisted coding (CAC) has become
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Edifecs and VirtualHealth Partner to Automate Prior Authorization
What You Should Know: - Today, Edifecs and VirtualHealth, a medical management company, announced a new partnership automated prior authorization to VirtualHealth’s HELIOS® platform for healthcare payer and provider clients. - The Edifecs solution will automate and optimize the prior authorization process across HELIOS to significantly reduce the administrative burden, alleviate friction between payers and providers, and ultimately expedite patient care. Growing Need for Automated Prior
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Half of the Patients With High-Deductible Health Plans Have Received Surprise Medical Bills
What You Should Know: - AKASA™, the leading developer of AI for healthcare operations, released findings from a survey conducted on its behalf by YouGov. - The findings highlight how patients with high-deductible health plans (HDHPs) suffer the downstream effects of a complex medical billing process, including surprise medical bills, inaccuThe findings highlight how patients with high-deductible health plans (HDHPs) suffer the downstream effects of a complex medical billing process,
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9 Executive Revenue Cycle Predictions/Trends to Watch in 2023
Nate Maslak, the co-founder/CEO of Ribbon Health Price Transparency: In 2022, we saw CMS’s Transparency in Coverage rule go into effect, requiring non-hospital entities like health plans and providers to publish publicly available rates for care. In 2023, we’ll see this price transparency data become more mainstream as it finally makes its way into the hands of patients, empowering them to find the best care for them, reevaluate their care choices, and shop around for the best possible care
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