Revenue Cycle Integrity
Expert articles and analysis related to revenue cycle integrity.
AI Summary — Last 24 Hours
Senate Republicans blocked an effort to end CMS’ WISeR Medicare AI prior authorization pilot, keeping alive a Trump administration test that directly affects revenue cycle integrity by adding algorithm-enabled utilization review pressure to selected traditional Medicare services and raising provider concerns about delayed care, denials, and appeal burden (Healthcare Dive). At the same time, Congress advanced separate Medicare Advantage prior authorization reform while insurers hedged on earlier denials-process commitments, creating a split-screen environment for ACOs, health systems, and VBC entities: more scrutiny of payer administrative friction, but no near-term retreat from CMS testing AI-enabled payment controls. CMS’ proposed changes around outsourced remote monitoring payment further signal tighter oversight of billing integrity and vendor-enabled care management economics, with implications for RPM-heavy population health models.
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From newsletter: The Week in Brief: States Turn Medicaid Spotlight on Business The Week in Brief: States Turn Medicaid Spotlight on Business Plus: Medicaid spending in California; prior authorization;...
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Couple Who Used to Live in Powell Indicted in $9.3 Million Medicaid Scheme: 10 Additional Medicaid Providers Charged in Separate Cases - Office of Inspector General (.gov)
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