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UnitedHealth, CVS and Humana used technology to increase MA prior authorization denials for post-acute services, boosting profits, according to a report from a Senate subcommittee.
Health systems that embrace artificial intelligence tools can not only improve radiology operations and quality but patient follow-up as well, which can result in greater staff efficiencies, higher patient completion rates and better access and outcomes for patients. A collaboration between East Alabama Medical Center, Inflo Health and the American College of Radiology Learning Network began using machine language models and advanced natural language processions to extract data from radiology re
Suki this week announced new plans to partner with Zoom Video Communications for artificial intelligence-enabled telehealth. WHY IT MATTERS The companies say Zoom will use Suki’s AI engine, Suki Platform, to generate clinical notes and will integrate other automation tools to boost provider experience and patient care. Suki's technology will help power ambient clinical documentation during Zoom telehealth visits and in-person visits.
Fierce Healthcare reporters returned from Las Vegas on Wednesday after four days packed with meetings, interviews and on-stage conversations all focused on healthcare innovation. | From AI (of course) to PBMs to women's health, here are some topics that got our attention at HLTH 2024.
Speaker: Simran Kaur, Co-founder & CEO at Tattva.Health
AI is transforming clinical trials—accelerating drug discovery, optimizing patient recruitment, and improving data analysis. But its impact goes far beyond research. As AI-driven innovation reshapes the clinical trial process, it’s also influencing broader healthcare trends, from personalized medicine to patient outcomes. Join this new webinar featuring Simran Kaur for an insightful discussion on what all of this means for the future of healthcare!
Ty Greenhalgh, Principal of Healthcare at Claroty In light of the recent Supreme Court decision overturning the Chevron deference, the regulatory landscape, especially concerning cybersecurity in healthcare, faces significant changes. The ruling in Loper Bright Enterprises v. Raimondo, which reversed the 1984 Chevron v. Natural Resources Defense Council precedent, alters how federal agencies can interpret and implement laws.
by Spencer Andrews What makes a city livable? The answer, some say, is more “ third places ,” spaces distinct from one’s home (the first place) and one’s workplace (the second place). A third place, like a café, park, or library, fosters the sense of community and connection that makes a neighborhood great to live in. This imprecise yet uncomplicated framing effectively refocuses a complex set of social, economic, and urban design issues on a simple solution to the “livability” problem.
If you’re participating in the Merit-based Incentive Payment System ( MIPS ) or MIPS Value Pathways ( MVPs ), you’ve likely encountered a familiar scenario: you review your estimated MIPS score in your dashboard, only to find that months later, when CMS releases the final score, the numbers don’t quite add up. For many providers, this discrepancy can lead to confusion, frustration, and even financial uncertainty.
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Health Care Compliance Brief brings together the best content for health law & compliance professionals from the widest variety of industry thought leaders.
If you’re participating in the Merit-based Incentive Payment System ( MIPS ) or MIPS Value Pathways ( MVPs ), you’ve likely encountered a familiar scenario: you review your estimated MIPS score in your dashboard, only to find that months later, when CMS releases the final score, the numbers don’t quite add up. For many providers, this discrepancy can lead to confusion, frustration, and even financial uncertainty.
Each week, more healthcare technology vendors add artificial intelligence enhancements to their products to optimize healthcare practice and provider efficiencies and personalize patient care. To that end, eClinicalWorks announced a series of artificial intelligence enhancements to its electronic health record products, including healow Genie – a fully integrated 24/7/365 contact center system while athenahealth launched Ambient Notes into the athenaOne platform.
Approximately 6.7 million Americans over the age of 20 currently live with heart failure, with this number projected to rise to 8.5 million by 2030. The lifetime risk of developing heart failure has increased to 24%. Despite advances in treatment, heart failure remains a significant cause of morbidity and mortality. Heart failure-related hospitalizations and deaths have been on the rise, reversing earlier improvements.
Intravenous fluid shortages appear to be affecting the majority of the nation’s healthcare providers, who as a result are already beginning to cancel procedures, survey data published Thursday show | Premier said 86% of its provider members are reporting shortages, and more than half have less than 10 days supply on hand. Respondents also said they were beginning or considering procedure cancellations, and have begun receiving solicitations from "unapproved, gray market suppliers.
The following is a guest article by Mike Crouse, Director of Insider Risk at Everfox Ransomware attacks on the healthcare sector continue to grow, with incidents nearly doubling from 2022 to 2023—a concerning figure considering their potential to leave patients in life-or-death situations. The recent ransomware attack on OneBlood , a blood center that serves hundreds of hospitals in the south, is just the latest example of a cyberattack having a real-world impact.
Based on comprehensive survey data from diverse healthcare providers, the 2025 HIPAA Benchmark Report delivers actionable intelligence for modern compliance programs. This report examines how organizations are restructuring HIPAA Privacy Programs to address emerging regulatory requirements. Through analysis of staffing models, program operations, and breach management protocols, it provides a clear picture of current best practices.
by Rebekah Ninan This past month, California Governor Gavin Newsom signed a wave of artificial intelligence-related legislation into law. Much public debate has been focused on SB 1047, a proposal ultimately vetoed by Governor Newsom, which would have held AI companies liable for “ catastrophic harms ” from AI models. Comparatively little attention has been paid to three new laws aimed at health care-related AI and data privacy.
Internal audits and monitoring are essential practices to ensure coding and billing compliance, protect revenue, and defend against payer audits and clinical denials. However, with limited time and resources, it becomes impossible to internally review every physician, patient type or risk area. In the October edition of HCCA Compliance Today , MRO senior director of revenue cycle, Dawn Crump and program manager of revenue integrity, Garnette McLaughlin, discuss new strategies for internal aud
In a world where consumers can order dog food, schedule a haircut or buy a plane ticket with just a few keystrokes, patients often are left wondering why healthcare has to be so complicated – and why so many processes seem stuck in the past. Today, as consumers grow more dependent on convenient and efficient online tools across retail, banking and grocers, patients are becoming increasingly aware of – and dissatisfied with – healthcare's digital deficiencies, which often cr
Whakarongorau Aotearoa (New Zealand Telehealth Services) is transferring to a new cloud host by the end of the year. It was announced that the government service will be an anchor tenant of IT giant Microsoft's upcoming hyper-scale cloud in New Zealand. Whakarongorau has been delivering free, government-funded, and round-the-clock national telehealth services across seven digital channels since 2015.
Every health care provider that accepts federal payments must screen for excluded providers. Use this sample Exclusion Screening Checklist and Compliance Policy to evaluate and improve your organization’s compliance with the law. Payments from Medicare, Medicaid, and TriCare trigger screening requirements that may extend to employees, contractors, volunteers, board members, and network providers.
Microsoft recently unveiled several new artificial intelligence capabilities for healthcare organizations designed to help analyze diverse medical data, streamline nursing documentation and enable | Microsoft recently unveiled several new AI capabilities for healthcare organizations designed to help analyze diverse medical data, streamline nursing documentation and enable companies to build their own healthcare AI agents.
Chu Canh Chieu, Director of Global Healthcare Center, FPT Software One of the silver linings of the COVID-19 pandemic was the rise of telemedicine. The constraints imposed by the pandemic sparked a lasting trend of patients willing and able to seek healthcare solutions virtually. Since the pandemic, the rise of AI and its integration with telemedicine and digital health has seen significant investment growth, leading to enhanced patient care and reduced operation costs for healthcare providers a
The following is a guest article b y Erin Weber , Chief Policy and Research Officer at CAQH Accurate provider data is foundational to the healthcare ecosystem. It guides decision-making, helps patients access the care they need, and keeps operations running smoothly behind the scenes. And while we’ve all acknowledged the challenge of keeping provider data up-to-date and error-free—especially with frequent changes in practice locations, credentials, and network participation—what we don’t talk ab
As health care continues its digital transformation, interoperability and data quality are critical to measuring and improving patient outcomes. Whether focused on HEDIS®, value-based care or broader quality measurement activities, reliable data—facilitated through Fast Healthcare Interoperability Resources (FHIR®) APIs and other interoperable systems—are essential for effective reporting, decision making and delivery of care.
Payroll compliance is a cornerstone of business success, yet for small and midsize businesses, it’s becoming increasingly challenging to navigate the ever-evolving landscape of federal, state, and local regulations. Mistakes can lead to costly penalties and operational disruptions, making it essential to adopt advanced solutions that ensure accuracy and efficiency.
Sunway partners with Medtronic to test surgical robotics Sunway Healthcare Group in Malaysia recently announced its partnership with Medtronic. According to a social media announcement, they signed a memorandum of understanding to work together to improve the centres of excellence at its flagship hospital, Sunway Medical Centre, which specialises in spine, neuroscience, and cardiovascular medicine.
Like most health systems across the United States, Pinehurst, North Carolina-based FirstHealth of the Carolinas has challenges with bed capacity and is always working on new and innovative ways to increase it in a safe and financially responsible way. THE PROBLEM This has been done through a few different venues. FirstHealth's extended care unit at its Richmond campus, among others, is a brick-and-mortar solution, whereas the observation at home (OAH) program helps with capacity challenges,
The products include a service that helps healthcare organizations build their own AI agents that could be used for appointment scheduling, clinical trial matching and patient triage.
The American Medical Association’s (AMA's) CPT Editorial Panel has removed the requirement for a patient to transmit 16 days’ worth of data for providers to bill remote physiologic monito | The American Medical Association's coding panel decided at its September meeting to eliminate the requirement for a provider to collect 16 days' worth of data from a connected device to bill the supply code.
Healthcare communication has evolved from handwritten notes and paper charts to digital tools like EHRs, telemedicine, and AI-powered platforms. This blog explores how these advancements improve patient outcomes, streamline care delivery, and enhance provider collaboration. Learn about the role of mobile health (mHealth) apps, secure messaging, and social media in bridging communication gaps.
Candid Health , the revenue cycle automation platform for healthcare providers, today announced a $29 million Series B led by 8VC with participation from existing investors First Round Capital, BoxGroup, and Y Combinator. This brings the company’s total amount raised to $47 million. Candid Health is on a mission to simplify medical billing, allowing providers to focus on delivering quality care.
Compliance isn’t just a box to check—it’s a vital responsibility that safeguards patient well-being and protects organizations from significant financial losses. Shockingly, over $54 billion is stolen each year through scams targeting patients and insurance companies with fraudulent medical charges, according to the NHCAA. This staggering figure highlights the importance of staying vigilant.
Demonstrating benefits to patients and clinicians will greatly drive interoperability, h ealth information exchange and medical record digitalisation in Asia-Pacific. Dr Mahesh Appannan, Ministry of Health Malaysia's head of digital health, Seyoung Jung, assistant professor and CIO of Seoul National University Bundang Hospital in South Korea, and Gareth Sherlock, chief executive of Turimetta Consulting and former CIO at Cleveland Clinic London and Abu Dhabi, delved into EMR implementation be
A new partnership with Amazone One Medical, which offers hybrid virtual and in-person primary care, aims to expand access to high-quality coordinated care in Northeast Ohio, Cleveland Clinic said in an announcement Monday. WHY IT MATTERS Patient access to essential health services is behind the collaboration, according to Dr. Tom Mihaljevic, Cleveland Clinic's chief executive officer and president, with the new practices to offer same and next-day appointments, an onsite lab and virtual care
Let's discuss the trusty pager—an old favorite that’s losing its shine in hospitals and clinics. While once a staple in hospitals and clinics, pagers now present significant limitations that hinder rather than facilitate communication among healthcare professionals. Healthcare professionals are constantly on the move, and they need communication tools that can keep up with their fast-paced lives.
Executives from Amazon, Walgreens, Blue Shield of California and PhRMA weighed in on how to fix the much-scrutinized pharmacy benefit manager model during HLTH 2024.
The Coalition for Health AI (CHAI) announced the completion of two draft documents on Friday that may have a big effect on the future of AI in healthcare. | After Deputy Secretary Andrea Palm announced that HHS will work with industry to develop a national network of quality assurance labs for AI, CHAI is releasing two draft documents that spell out how to certify those assurance labs and an AI "nutrition label" for healthcare decision-makers.
The following is a guest article by Lee Jones, Chief Product Officer at Gozio Health A 2024 McKinsey & Company survey found nearly 90% of health system executives —representing both technical roles (CIOs, CTOs) and nontechnical roles (CEOs, CFOs)—ranked digital and AI transformation as a high priority. Yet 75% of respondents believe that their organizations aren’t dedicating enough planning or resources to deliver on the promise of digital transformation.
Assisted living facilities are a lifeline for elderly and vulnerable individuals who need care and support in a safe, nurturing environment. Yet, even in these compassionate settings, caregivers often face the challenge of managing aggressive behaviors among residents. Imagine the case of Mrs. Stevens, a once gentle and kind woman who, after the onset of dementia, began exhibiting sudden outbursts of anger.
Large enterprises face unique challenges in optimizing their Business Intelligence (BI) output due to the sheer scale and complexity of their operations. Unlike smaller organizations, where basic BI features and simple dashboards might suffice, enterprises must manage vast amounts of data from diverse sources. What are the top modern BI use cases for enterprise businesses to help you get a leg up on the competition?
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