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Digital payment modalities aren’t enough: How health plans can build provider payment confidence
As administrative costs rise and reimbursement grows more complex, both health plans and providers are under increasing pressure to improve…
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Sarasota Memorial Health Care System increased discharges by 70% across sites and reduced length of stay by 13 hours. Texas Oncology grew infusion volume by 16% without adding staff or chairs. The University of Kansas Health System raised OR utilization…
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Revenue cycle teams are under pressure — and adding more labor isn’t the answer. Healthcare organizations are being asked to reduce administrative burden, improve financial performance and modernize operations all at once. But for many leaders, separating meaningful AI innovation…
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Brittany Rambino
Vice President of Revenue Cycle Management, Ambry Genetics
Kyle Fetter
Chief Operating Officer, XiFin, Inc.
Jeff Carmichael
Senior Vice President of Engineering, Analytics, and AI, XiFin, Inc.
Medicare Payment Advisory Commission insights, Congressional reports and enrollment data have all been released in the early months of 2026. Some methodology has been questioned by insurers and CMS, even directly on the Congressional floor. Despite the challenges, here are…
Texas saw the largest increase in bronze ACA plan enrollment from 2025 to 2026, while West Virginia saw the largest decrease, according to CMS data analyzed by KFF. Bronze plan enrollment grew 26% nationally, from 7.3 million to 9.2 million,…
The day after CMS released its final 2027 Medicare Advantage and Part D payment rule, Chris Klomp, director of Medicare and deputy administrator at the agency, sat down with Health Tech Nerds Radio podcast to walk through what changed, what…
CMS has issued operational guidance to states regarding how to implement H.R. 1’s Medicaid coverage restrictions for noncitizens, which take effect Oct. 1. On April 8, the agency outlined how states must update eligibility systems, applications, verification processes and claims…
Thirty-six percent of providers believe payers reliably deliver on promises, according to an inaugural Aetna provider survey released April 8. The survey will run quarterly, polling representatives of U.S. healthcare providers. This round fielded responses from 827 hospital system executives, physicians, nurses,…
AP of South Florida, a Florida-based insurance brokerage, has agreed to plead guilty to one count of major fraud against the U.S. for its role in a fraudulent ACA enrollment scheme. In a parallel civil resolution, AssuredPartners, a national brokerage…
Risk adjustment strategies built on retrospective chart chase are no longer just inefficient — they are increasingly financially exposed. As RADV audits expand and regulatory scrutiny intensifies, payer organizations are being forced to rethink not just how risk is captured,…
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John Murtha
Health Plan Executive, InterSystems
Many payer-provider partnerships start with strong alignment but fail to deliver sustained results. In this webinar, leaders share what it takes to move from intent to execution — building trust, aligning operations and delivering consistent value across markets, provider types…
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Neil Kulkarni
VP Product Management – Provider & Clinical, Highmark
Hussain Sheikh
VP Product Development & Management, enGen
Gaurav Tiwari
Partner, Health Plans & Provider Practice, ZS
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