Payer Systems

Recently, a report from the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) has highlighted missed opportunities by states to improve maternal health access through Medicaid managed care organizations (MCOs). The report points out significant gaps in insurance

The state of Vermont is navigating a profound healthcare crisis that has necessitated comprehensive reform efforts aimed at revitalizing its healthcare system. Spearheaded by the Green Mountain Care Board (GMCB), these efforts are driven by a critical need to achieve financial sustainability,

In today's rapidly evolving healthcare landscape, revenue cycle management (RCM) remains a critical challenge for health systems. With payer complexities, staffing shortages, and cybersecurity concerns on the rise, many healthcare executives are reevaluating their strategies. A recent survey

Healthcare revenue cycle management has always been a complex and multifaceted process. With evolving payer requirements, increasing denial rates, and significant workforce shortages, the need for innovative and efficient solutions has never been more urgent. Artificial Intelligence (AI) and

Clinicians across major health systems in the United States are increasingly turning to AI-powered documentation tools to alleviate the heavy administrative burden that often detracts from patient care and contributes to burnout. By adopting these technologies, healthcare providers aim to

The healthcare industry can often feel like the Wild West, with standoffs not uncommon. One such recent dispute saw Infirmary Health, Alabama's largest nonprofit health system, facing off against UnitedHealthcare, the United States' largest commercial health insurer. At the heart of this