reimbursement

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.

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

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.

Todd Van Meter, Accuity CEO, talks about how the company helps providers reduce clinical denials by pairing physician-led review with AI that parses medical records to ensure error-free coding and documentation.

In the best case scenario, hospitals “are getting 20% less than the lowest workman’s comp fee schedule in the country,” says Zachary Schultz of EnableComp.

Arintra CEO Nitesh Shroff says the company's AI-powered platform turns complex clinical documentation into explainable, compliant codes that help reduce claim denials and support improving health systems' bottom lines.

While shorter-term fixes like renegotiating payer contracts can help, Wipfli's Kelly Arduino recommends that hospitals heavily dependent on Medicaid rebuild community philanthropy and endowments.