Reimbursement

Brian Smith, chief pharmacy officer at Shields Health Services, says that, while automation and AI can speed up the prior authorization process, patients may face other barriers to care that require human intervention.

Ambient AI relieves clinicians' cognitive burden by capturing visits and drafting patient notes so they can be fully present in the encounter and patients feel seen and heard, says Matt Troup, clinical strategy principal at Abridge.

Lalithya Yerramilli, Cohere Health's SVP of payment solutions, says the company uses AI to streamline prior authorization and reimbursement processes but not to deny care or claims.

As CMS deploys AI tools and data analysis to uncover possible Medicare and Medicaid fraud, COO Kimberly Brandt explains that suspected providers are offered education on billing rules and three chances to correct any errors.

As CMS removes procedures from its Inpatient-Only (IPO) list, Allison Oakes, Trilliant's chief research officer, recommends that hospitals establish a clear outpatient strategy to avoid losing the income these procedures bring.

Revenue growth will come from clinical outcomes versus document mechanics, says Steve Mongelli, president at mPulse.

Despite tightening barriers to entry over the years, Europe and the US are still key to global expansion for Korean startups, says Sky Labs CEO Jack Byunghwan Lee.

Janus Health's Carol Howard says the WISeR model's AI-driven reviews of specific Medicare services may trigger denials. To avoid this, hospitals must align clinical documentation with local and national coverage determination rules.

Sallie Gustafson, Murj's director of medical affairs, says Emory used smart remote monitoring technology that integrates with EHR systems to increase billable remote cardiac services by 52% despite minimal patient growth.

According to Sallie Gustafson, RN, Murj’s director of medical affairs, strict CMS billing rules may negatively impact practices’ recurring revenue from their remote cardiac monitoring services.