Finance/RCM (104)

Matching financial incentives to patient outcomes is necessary to getting away from fee-for-service, says Brian Overstreet, CEO of Arbital Health.

Giving patients visibility into procedure costs can reduce surprise billing and drive prices down through competition, according to HIMSS Policy Influencer Changemaker Leigh Burchell, VP for policy and public affairs at Altera Digital Health.

Kimberly Brandt, CMS COO, discusses the agency's Comprehensive Regulations to Uncover Suspicious Healthcare (CRUSH) fraud-fighting initiative and invites the public to submit ideas on how to improve its efforts.

Point-of-Care Partners' Vanessa Candelora says price transparency for services and medications will make it possible for patients to budget for procedures and to shop for better prices with providers in their insurance network.

The phase-out of the Medicare Inpatient-Only list drives value and efficiency, but hospitals lose out on volume and revenue, says Allison Oakes, chief research officer for Trilliant Health.

CMS says about 25% of the spend is fraudulent or being abused by providers, says Carol Howard, vice president of innovation and adoption at Janus Health.

MENA-based healthcare organizations are creating fully connected digital ecosystems and shifting to value-based care. Because of this, Mazin Gadir of Alvarez & Marsal says basic EMRs are no longer enough for these health systems.

Electrophysiologists, who implant devices such as pacemakers, need technology to automatically determine when the billing period ends, says Sallie Gustafson, RN, director of Medical Affairs at Murj.

A Murj survey verified billing is the undisputed top concern for electrophysiologists, says Sallie Gustafson, RN, director of Medical Affairs at Murj.

Todd Van Meter, CEO of Accuity, says that when partnering with clients, initial clinical denial rates are nearly cut in half and following an appeals process using an AI-driven platform, the final denial rates end up at 1% to 1.5%.

Join the editors of the HIMSS Media brands for a wide-ranging discussion about an eventful 2025 for digital health transformation: regulatory and reimbursement changes, cybersecurity challenges and, yes, a whole lot of AI.

Arintra aims to be a bridge for aligned incentives and shared transparency for accurate, compliant and explainable coding, says CEO Nitesh Shroff.