Payers are applying artificial intelligence to examine more claims and apply adjudication logic at a scale most organizations cannot match. Industry research shows 84% of health insurers report using AI or machine learning in some capacity. Providers are unlikely to…
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Growth is on the table for a lot of organizations right now: new locations, a multi-specialty acquisition, possibly a private equity partner. The revenue cycle has to scale with it.A hybrid model creates that room. Keep the functions your team…
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Nearly 90% of health IT leaders say their operations have to change to keep pace with rising clinical, regulatory and financial complexity, according to a 2026 survey from CHIME. Eighty percent of them called interoperability a baseline expectation rather than…
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There was no single metric that told Dr. Mary Affee her practice had outgrown its operations, and that was the frustrating part. She had built Horizon Integrated Wellness in Cary, N.C., from the ground up as a clinician. The systems…
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CMS said its enforcement efforts have resulted in blocking more than $1.6 billion in possibly improper Medicare lab payments throughout President Trump’s administration. An Aug. 28 CMS news release said these enforcement actions included savings of $732 million from 157 providers with…
The Labor Department is proposing a rule that would set criteria for employer associations to sponsor association health plans that qualify as employee welfare benefit and group health plans under the Employee Retirement Income Security Act. Received by the Office…
Federal enforcement around Medicare Advantage risk adjustment and billing has ramped up over the past two years, producing multimillion-dollar settlements with insurers, provider groups, and the vendors that handle their diagnosis coding. The combined value of the settlements comes to…
Florida Attorney General James Uthmeier has filed a lawsuit against Prime Therapeutics and Cigna’s Express Scripts, alleging the pharmacy benefit managers entered into an illegal horizontal price-fixing agreement that threatens access to affordable medications. The lawsuit alleges the competitors entered…
A federal judge has denied Elevance Health’s request for an emergency recalculation of its 2026 Medicare Advantage star ratings. On Aug. 27, U.S. District Judge Lisa Godbey Wood ruled that Elevance waited too long to file for the emergency recalculation…
Cigna Healthcare is launching a product that bundles supplemental health benefits directly into high-deductible health plans. The product, Medical with Smart Coverage, will be available in 2027 for employers with 500 to 2,999 employees offering qualifying HDHPs. Eligible employees can…
