Finance/RCM - HIMSS TV Homepage

Preparing for the new Medicare prior auth model

Providers in six states face new financial risks and training burdens under mandatory WISeR review, which leverages machine learning to control costs and expedite care. It's going to be "a steep learning curve," says Jeff Ladner, CPO at Onspring.

Preparing for the new Medicare prior auth model

Providers in six states face new financial risks and training burdens under mandatory WISeR review, which leverages machine learning to control costs and expedite care. It's going to be "a steep learning curve," says Jeff Ladner, CPO at Onspring.

6:18

3:27

Accurate provider directories are needed for patient access

The work of updating provider directories is the responsibility of payers, and much of it is still being done manually with mistakes incurring heavy penalties, says Megan Schmidt, CEO at Madaket Health.

Accurate provider directories are needed for patient access

The work of updating provider directories is the responsibility of payers, and much of it is still being done manually with mistakes incurring heavy penalties, says Megan Schmidt, CEO at Madaket Health.

3:27

9:29

Countdown to Interoperability and Prior Authorization Final Rule

Payer-provider collaboration in data exchange is being mandated and payers must speed up the prior authorization process, says Courtney Yeakel, chief product officer of the Payer Unit at Veradigm.

Countdown to Interoperability and Prior Authorization Final Rule

Payer-provider collaboration in data exchange is being mandated and payers must speed up the prior authorization process, says Courtney Yeakel, chief product officer of the Payer Unit at Veradigm.

9:29

11:06

Hospitals are weighing the impact of tariffs

Providers are concerned about whether they have contract protections against supply chain rate hikes due to tariffs, says Ralph Keiser, CEO of ArcheHealth.

Hospitals are weighing the impact of tariffs

Providers are concerned about whether they have contract protections against supply chain rate hikes due to tariffs, says Ralph Keiser, CEO of ArcheHealth.

11:06

9:43

Hospitals are preparing for decreased Medicaid reimbursement

To collect all the money they're owed, hospitals should ensure they have proper coding and pricing for services and look for community funding, says Kelly Arduino, Healthcare Industry Leader at advisory firm Wipfli.

Hospitals are preparing for decreased Medicaid reimbursement

To collect all the money they're owed, hospitals should ensure they have proper coding and pricing for services and look for community funding, says Kelly Arduino, Healthcare Industry Leader at advisory firm Wipfli.

9:43

6:31

Making prior authorization 'a thing of the past'

At AHIP 2025, Surescripts presented a scenario in which prior auth is done in 30 seconds using coordination between the physician, PBM and the EHR, says Matt Koehler, VP of product innovation at Surescripts.

Making prior authorization 'a thing of the past'

At AHIP 2025, Surescripts presented a scenario in which prior auth is done in 30 seconds using coordination between the physician, PBM and the EHR, says Matt Koehler, VP of product innovation at Surescripts.

6:31

7:05

How AI is reshaping the revenue cycle

Agentic AI learns and can evaluate claims to make faster decisions to drive improved reimbursement, says John Yount, Chief Innovation Officer at FinThrive.

How AI is reshaping the revenue cycle

Agentic AI learns and can evaluate claims to make faster decisions to drive improved reimbursement, says John Yount, Chief Innovation Officer at FinThrive.

7:05

6:37

Automated data reduces EHR crowding and care gaps

Veradigm is consolidating payer apps attached to EHRs by 15% to simplify providers' days and eliminate patient care gaps by up to 80%, based on larger provider groups, says Megan Zakrewsky, VP of product for clinical data exchange.

Automated data reduces EHR crowding and care gaps

Veradigm is consolidating payer apps attached to EHRs by 15% to simplify providers' days and eliminate patient care gaps by up to 80%, based on larger provider groups, says Megan Zakrewsky, VP of product for clinical data exchange.

6:37

5:19

Number of providers taking downside risk is growing

Sixty percent of all healthcare payments are in some form of value-based care, says Dave Snow, CEO of Cedar Gate Technologies.

Number of providers taking downside risk is growing

Sixty percent of all healthcare payments are in some form of value-based care, says Dave Snow, CEO of Cedar Gate Technologies.

5:19

8:46

Studying MedPAC's claim of favorable selection in MA

Real-world encounter data shows individuals enrolled in a MA plan are more likely to have a chronic condition than those who sign up for original Medicare, says Inovalon's VP of research science and advanced analytics, Christie Teigland.

Studying MedPAC's claim of favorable selection in MA

Real-world encounter data shows individuals enrolled in a MA plan are more likely to have a chronic condition than those who sign up for original Medicare, says Inovalon's VP of research science and advanced analytics, Christie Teigland.

8:46

8:05

How can your big AI investments drive value enterprise-wide?

Tom Lawry, managing director of Second Century Tech, says too few healthcare organizations are getting adequate ROI on their artificial intelligence investments. He offers some perspective on achieving value at scale.

How can your big AI investments drive value enterprise-wide?

Tom Lawry, managing director of Second Century Tech, says too few healthcare organizations are getting adequate ROI on their artificial intelligence investments. He offers some perspective on achieving value at scale.

8:05

9:40