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AmeriHealth Caritas has made a “strategic investment” in Deon Health, a Michigan-based managed care organization that serves people with intellectual…
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Bring external payer data into a health system and it can look like a one-time integration project — connect, map, deliver, done. It rarely works that way. Teams must track expected files, validate incoming data, interpret payer-specific formats, reconcile claims…
Presented by:
- Rob Pinataro, CEO, Health Data Innovations
- Christopher Ragsdale, Founder and Principal, Towers Advisory
- John Supra, Founder and Managing Member, Better Health Matters
- Jonathan Kaye, Founder and Executive Chairman, Health Data Innovations
Federal auditors found that 13 percent of the prior authorization requests Medicare Advantage plans denied met Medicare coverage rules, care that likely should have been approved. The pressure that creates lands on the revenue cycle. This report shows how health…
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Hospital revenue loss rarely begins with a bad claim. It often begins days or weeks earlier, when a service is scheduled before authorization requirements are confirmed, documentation is incomplete or the final service no longer matches what was approved. That…
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A fully staffed perioperative team is essential to safe, efficient surgical care — and rising procedural demand, clinician shortages and anesthesia constraints keep testing it. But workforce shortages are only half the problem. The other half is deployment: getting the…
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New York City-based Mount Sinai Health System is no longer accepting some new patients with government-backed health coverage, according to since-removed notices on its website. An archived webpage shows how Mount Sinai stopped accepting new patients with Centene’s Fidelis Care Medicaid, exchange…
The average end-of-year balances for health savings accounts reached $5,532 in 2024, up from $4,747 the year prior. However, that balance fell far below out-of-pocket maximums. In 2025, out-of-pocket maximums for HSA-eligible health plans were $8,300 for individual coverage and…
by: LocumTenens.com Mergers, physician group exits and service line changes rarely arrive with a convenient pause. Schedules still need filling. Quality and safety metrics still need to hold. And whoever owns clinical staffing suddenly faces a problem that looks nothing…
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Most revenue cycle teams are not underperforming because people are not trying. They are underperforming because the work is scattered. Every added vendor creates another handoff. Every handoff creates a place where accountability goes soft and a claim can sit.…
Presented by:
- Alicia Johnson, Associate VP of Revenue Cycle, Lake Regional Health System
- Nicole Rogas, President, RevSpring
New York’s Medicaid program failed to ensure that insurers administering the program were not denying prior authorization requests for mental health services at higher rates than for medical services, an audit report published Aug. 14 by the HHS Office of…
The Pharmaceutical Care Management Association and its members committed to sharing TrumpRx’s cash prices for drugs through their real-time benefit tools and other cost transparency platforms. An Aug. 13 news release said the association coordinated with the Trump administration and…
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