Revenue Cycle Management

Prior authorization volumes are climbing and payer policies shift mid-year. Denial rates continue to rise across the industry. In that environment, the pull for revenue cycle teams is to pursue every new problem, respond to every escalation, chase every trend.…

DRG downgrades, clinical validation denials and medical necessity denials — the denials now filling most queues — share a trait: none of them dispute the care delivered. They dispute how the record reads once the case is closed, which means…

Oracle Health unveiled five AI capabilities for its revenue cycle management portfolio Sept. 23. The tools are designed to flag denials, authorization problems and charge errors early in the patient and payment journey, before they delay reimbursement. The company announced…

Ember AI, a Burlingame, Calif.-based, AI-powered revenue integrity platform, said the company achieved 433% growth of its customer base over the past year while maintaining 100% customer retention, according to a Sept. 22 news release shared with Becker’s. The platform…

Artificial intelligence has arrived on both sides of the hospital-health plan negotiating table, and Deborah Greer, MD, wants to make sure one thing doesn’t get lost in the speed: the physician who has to own the call. Dr. Greer is…

CMS is preparing to reset Medicare laboratory payments in 2027 after the agency said new private-payer data showed the program is paying substantially more than commercial insurers for many clinical tests. The agency said preliminary rates under the Clinical Laboratory…

AI and automation are helping reduce repetitive work for revenue cycle teams, pushing them towards greater capabilities for data literacy and problem solving, four revenue cycle leaders said at Becker’s 11th Annual Health IT + Digital Health + RCM Conference.…

From Carle Health to NYC Health + Hospitals and Cleveland Clinic, three revenue cycle leaders at Becker’s 11th Annual Health IT + Digital Health + RCM Conference shared stories of their biggest wins and what they plan to tackle next.…

Four revenue cycle leaders at the Becker’s 11th Annual Health IT + Digital Health + RCM Conference are shedding light on how denial rate – once a most trusted scorecard in revenue cycle – is a metric that no longer…

While hospital leaders debate which revenue cycle tasks to automate and where AI yields the best ROI, a major shift is underway: the other side of the claim is already using AI. Large payers are deploying artificial intelligence to review…