Reimbursement

An automated electronic PA process uses FHIR interoperability for greater efficiency, says Greg LeGrow, executive director of payer product market strategy at athenahealth and Mark Fleming, senior director of product at Availity.

Also, MediBuddy in India has developed an AI to detect fraudulent claims.

Healthcare attorney and partner at Holland & Knight Zubin Khambatta discusses the CMS final rule related to Medicaid managed care and its provisions adding new compliance guardrails regarding state-directed payments.  

Jorie AI CEO Sal Lo discusses his company's product that helps reduce administrative workload and enables healthcare organizations to speed up eligibility verification and claims processing.  

Dr. Harm Scherpbier, HealthShare Exchange CMIO, describes how the company's platform connects practices, payers and ACOs, allowing them to share patients’ data in real time across facilities to coordinate care seamlessly.  

Andy Molnar, CEO of the Digital Therapeutics Alliance, discusses the definition of a digital therapeutic, companies in the DTx space, why the organization held its recent summit in D.C. and the status of the Prescription Digital Therapeutics Act.  

ChartSwap president Nate Kelly relays how patients and providers benefit from the company's electronic record request fulfillment, allowing them to review authorizations and receive faster payment for their time by automating custodian fees.

David Wolf, MedeAnalytics AVP, and Lynn Carroll, HSBlox COO, highlight value-based care models' crucial components, including contract modeling and performance measurement, and discuss change management for switching to these models.  

Cedar Gate Technologies EVP David Morris compares the new model, which allows for a gradual approach to risk for more conservative and less experienced ACOs, and ACO REACH, which requires a greater tolerance for risk, but has more rewards.    

Khue Tran, chief strategy officer at Azalea Health, shares how the company's products for rural health systems, including EHR and practice management software, RCM automation and touchless charting, drive efficiencies and boost reimbursement rates.