Claims & Payment Integrity
Expert articles and analysis related to claims & payment integrity.
AI Summary — Last 30 Days
Over the past 30 days, CMS under the Trump administration has accelerated structural reforms to Medicare payment models, with more than 150 organizations applying to the new ten-year ACCESS model—a signal of broad sector interest despite provider concerns over lean payment rates and voluntary participation requirements (Medical Economics, [Healthcare Finance News](https://news.google.com/rss/articles/CBMiowFBVV95cUxOVnh1X2NqX0VfVXVXNWxVdzFVVHFHM0trYlFNTWVEZFRGNn
Related Articles
Future-proofing payment integrity: How to gain more value now while scaling for future growth
Future-proofing payment integrity: How to gain more value now while scaling for future growth Fierce Healthcare
Predict, prevent, perform: The AI evolution of denials management
Healthcare providers continue to face escalating denial rates that erode financial performance and operational capacity. In 2025, denial rates averaged near 12%, with many organizations experiencing e...
The KPIs that define revenue cycle excellence
Revenue cycle leaders face significant challenges with shrinking reimbursements, rising denials, and operational complexities, requiring more than basic reporting for improvement. The HFMA MAP Keys pr...
Payer denials and prior authorization delays are top RCM concerns
Hospitals are looking to AI automation to streamline revenue cycle processes and to offset payer denials, their biggest issue, according to a survey by the Healthcare Financial Management Association,...
Stop Waiting to Be Asked: What Operators Really Need From Their Revenue Cycle Partners
Stop Waiting to Be Asked: What Operators Really Need From Their Revenue Cycle Partners MedCity News
Waystar builds out AI solution to uncover lost provider revenue from payer 'take-backs'
Waystar builds out AI solution to uncover lost provider revenue from payer 'take-backs' Fierce Healthcare
Using automation and outsourcing to improve RCM
Using automation and outsourcing to improve RCM Spiceworks
Hospitals' net revenue leakage increases 25% due to denied claims
Insurers denied more claims on clinical grounds in 2025 compared with 2024, leading to a 25% increase in net revenue leakage at hospitals, according to a new report by Kodiak Solutions.
Inside Mercy’s Revenue Cycle Strategy to Reduce Denials and Push Back on Payer AI
Inside Mercy’s Revenue Cycle Strategy to Reduce Denials and Push Back on Payer AI HealthLeaders Media
Winning the arms race between billing complexity and payment accuracy
High-dollar claims are the new baseline. Is your payment integrity strategy built to keep up?