Miami-Dade County Commissioners voted Aug. 13 to replace AvMed with Aetna to administer health benefits for more than 31,000 employees, the Miami Herald reported. AvMed held the contract since 2007 and has filed a legal challenge over the bidding process. …
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CMS has lifted an enrollment suspension on Wellcare of Missouri’s Medicare Advantage prescription drug plan, effective Jan. 1, 2026. The sanction was originally imposed Sept. 6, 2024, after Wellcare failed to meet the federal minimum medical loss ratio of 85%…
Staffing shortages, inflation and payer friction now cost hospitals billions. Yet digital payment volume is set to quadruple, opening new revenue opportunities if teams can process the work. Automation and AI are quickly becoming must-have tools, not future nice-to-haves. …
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Presented by:
Presenters
Lauren Tungate
St. Manager, Solution Strategy, Waystar
Revenue cycle leaders are under immense pressure to prevent denials, improve payment accuracy and relieve administrative burden. But manual workflows can’t keep pace with the demands of modern RCM. This new Forrester Consulting report reveals how health systems using AI…
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Medicare Advantage enrollment in rural America has quadrupled since 2010, reaching 40% of eligible beneficiaries in 2023, but still far below the 53% penetration in metropolitan areas. Rural beneficiaries now have an average of 27 MA plans to choose from,…
With high-deductible health plans on the rise, denials increasing and a greater share of receivables coming directly from patients, hospital margins are under significant strain. Capturing every last dollar has become critical to revenue protection. Keck Medicine of USC is…
Sep 22, 2025 1:00 PM - 2:00 PM America/Chicago
Presented by:
Presenters
John Yount
Chief Innovation Officer, FinThrive
Rudy Braccili
Senior Director Revenue Cycle Operations, Keck Medicine of USC
Employers are expecting a median healthcare cost increase of 10% in 2026, according to a survey from the International Foundation of Employee Benefit Plans. The results reflect the responses from 150 corporate and single employers surveyed between July 30 and…
The CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F) represents a significant compliance lift. However, payers have the opportunity to leverage the rule as a means to accelerate broader transformation. From streamlining prior authorizations to integrating clinical, claims and SDOH…
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With CMS-0057 on the horizon — and growing friction with providers and members — health plans know utilization management needs more than a tune-up. But fragmented systems, outdated policies and poor access to clinical data continue to slow progress. In…
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Claims denials are on the rise and already costing nearly $20 billion per year. And, as payers continue to integrate AI into denial processes, revenue cycle teams are turning to generative AI to respond to denials faster and smarter. In…
Sep 15, 2025 12:00 PM - 1:00 PM America/Chicago
Presented by:
Presenters
Hanes Singh
Founder and CEO, DocVocate
Rob Swisher
Chief Executive Officer, MedRevenu