After waiting weeks for an open appointment, John finally gets in to see the orthopedic surgeon to evaluate his acute knee pain. He’s already been off work for over two months and has barely been able to leave the house, popping anti-inflammatory and pain medicine to manage the pain every day.
Suspecting a torn meniscus, the doctor orders an MRI to verify the diagnosis and plan his treatment approach. The nurse begins the process by calling John’s insurance carrier to verify coverage,
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Revenue Cycle Management | News, Analysis, Insights - HIT Consultant
Edifecs Partners with Empowered-Home to Deliver Automated Prior Authorizations
What You Should Know:
- Edifecs and Empowered-Home announced a partnership to provide automated prior authorizations to medical associations, Accountable Care Organizations (ACOs), Independent Physician Associations (IPAs), medical groups, and home health care agencies.
- The Edifecs prior authorization solution combined with the clinical decision support system of patient management software company, Privis Health, forms the backbone of Empowered-Home’s ecosystem. Empowered-Home is
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Why Data Transparency Is the Most Important Metric for Healthcare Providers Right Now
Healthcare providers all over the world are battling with how to take patient information and patient care digital. How can we use the tools and technology at our fingertips to make treating patients easier and more effective, rather than more complicated? Converting data into useful information will be the key to making this transition successful.
Data is the currency, language, form, and function of digital transformation in healthcare. Having an easily accessible data warehouse and
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Zelis Acquires Healthcare Payment Reimbursement Solutions Payspan
What You Should Know:
- Zelis, a company modernizing the business of healthcare, announced today the completion of its acquisition of Payspan, a leader in healthcare electronic payment and reimbursement automation services. Financial terms of the transaction were not disclosed.
- The acquisition will accelerate Zelis' mission to modernize the business of healthcare through a connected platform and expansion of offerings for healthcare insurers, providers, and their members.
Improving
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Fathom Secures $46M for AI Medical Coding Automation Platform
What You Should Know:
- Fathom, an AI-powered medical coding automation platform raises $46M in Series B funding co-led by Alkeon Capital and Lightspeed Venture Partners with participation from Vituity’s Inflect Health, Cedars-Sinai, ApolloMD, Jonathan Bush, and other healthcare executives.
- The company plans to use the funding to advance the standard in automated medical coding in response to critical challenges facing providers. The Series B round brings Fathom’s total funding to
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Debunking 3 Common Myths About Healthcare Revenue Cycle Partnerships
The healthcare industry is facing unprecedented challenges, including severe labor shortages. According to a recent study, more than nine in 10 health systems and physician groups are experiencing a workforce shortage in revenue cycle management (RCM), with many of those reporting vacancies in over half of their RCM roles. This is one of the many reasons why there has never been a better time for health systems to think outside the box for solutions, including an RCM partnership. Often, when
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Cedar Launches Payer Intelligence Layer to Integrate Payer-Provider Data
What You Should Know:
- To address the systemic challenges consumers face when paying for healthcare, Cedar, an enterprise healthcare engagement platform that improves the end-to-end consumer financial journey, has developed the Payer Intelligence Layer.
- With the Payer Intelligence Layer, Cedar can now integrate data from health insurers and healthcare providers to help create a single source of information for consumers managing medical bills. A game-changer for the healthcare industry,
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KLAS-Bain: Post-Pandemic Investment Priorities for Healthcare Providers
What You Should Know:
- Competition in the provider IT space shows no signs of abating: Early-stage capital, big tech, and scale EMR players continue crowding into more segments. This has significant implications for providers as they transition into a new disruptive period, for software players as they fine-tune go-to-market models for the current environment, and for private equity investors as they look to invest behind winning themes.
- A new report by KLAS Research and Bain &
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Healthcare Payments: 3 Ways to Make the Experience Better for Patients and Providers Alike
The past few years have seen an enormous acceleration in the adoption of technologies that streamline and modernize payments across all industries. As embedded finance becomes more popular and companies begin to embrace automation technologies, there’s a clear opportunity for healthcare providers to embrace digital payments. Through the use of digital payment technology, healthcare professionals can make their services easier for their vendors, suppliers and patients.
Simplifying the Patient
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Humana Taps Cohere Health to Streamline Prior Authorizations for Cardiovascular & Surgical Specialties
What You Should Know:
- Health insurer Humana has expanded its partnership with Cohere Health to streamline the prior authorization process for cardiovascular care and surgical specialties. Both these care pathways are clinically complex, involving multiple exchanges between primary care physicians and specialists, which can contribute to costly and unnecessary variations in care.
- For surgical services, Humana staff will use the Cohere Unify™
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