Providers continually struggle to get the fair reimbursement they deserve from payers and often feel powerless to negotiate better rates. However, regulatory changes aimed at increasing price transparency and prohibiting gag...more
Value-based care (VBC) is a healthcare delivery model that prioritizes patient outcomes over the volume of services provided. This approach aims to enhance the quality of care while controlling costs by incentivizing...more
1/24/2025
/ Alternative Payment Models (APM) ,
Centers for Medicare & Medicaid Services (CMS) ,
Compliance ,
Health Care Providers ,
Health Insurance ,
Healthcare Reform ,
Hospitals ,
Medicaid ,
Medicare ,
Physicians ,
Regulatory Requirements ,
Reimbursements ,
Value-Based Care ,
Value-Based Payments
Use of algorithms and artificial intelligence (AI) in prior authorization and utilization management is facing growing criticism and litigation. Notable lawsuits include alleged automatic authorization denials for tests that...more
3/1/2024
/ Algorithms ,
Artificial Intelligence ,
Bias ,
Centers for Medicare & Medicaid Services (CMS) ,
Denial of Insurance Coverage ,
Discrimination ,
Health Insurance ,
Healthcare ,
Innovative Technology ,
Life Sciences ,
Machine Learning ,
Medicaid ,
Medicare ,
Patient Access