Claims Processing

As ambient conversations unfold, physicians have access to evidence-based guidance through a new partnership between Abridge and NEJM and JAMA and ease downstream coding burdens, says Abridge Clinical Strategy Director Matt Troup.

Misaligned incentives cause providers and payers to go back and forth on claims, but they may be approaching the same goals from different perspectives, according to Lalithya Yerramilli, SVP of Payment Solutions for Cohere Health.

The payer says its initiatives will stabilize the financial health of independent rural hospitals and improve patient access to care.

Members of Congress from affected states are hoping to repeal the AI-focused Medicare prior auth model, claiming it privatizes care delivery and harms patients.

Several companies have released artificial intelligence enhancements for healthcare administration and operations, from billing and staffing to security and data management. Also, the VA will scale ambient scribing.

Verlon Johnson discusses how technology can help states make Medicaid processes more efficient while improving care delivery – and describes ways providers can address health disparities and improve outcomes for underserved populations​.

The intelligent automation will deliver more timely decisions that reduce delays and improve access to care, Optum says.

While hospitals and health systems continue to face an array of significant challenges, human-centered innovations that pair data with agility are helping improve caregiver experience and patient care, the research firm says. 

Artificial intelligence does not replace coder judgment – it instead acts as a consistent second set of eyes, flagging areas that may warrant attention and providing supporting evidence, says the CFO of the health system's human-in-the-loop process.

The AI assistant offers personalized answers to members’ health benefit questions.