Microsoft has launched the claims denial navigator, an AI-powered tool designed to help rural hospitals manage denied insurance claims and improve revenue collection. The tool is available through GitHub and provides actionable recommendations for billing staff while learning from their feedback to enhance claim resolutions. Scott McEachern, CIO of Southern Coos Hospital & Health Center in Oregon, said, 'Our revenue cycle team leveraged the denial management app to support the transition to a new electronic health record system, reducing the legacy rundown timeline by several months. Participation in the RHAIL program also demonstrated the value of developing low-cost, targeted applications in key operational areas like revenue cycle.'
The AHA urged Aetna to rescind its recently announced “level of severity inpatient payment” policy, saying that it “could erode the transparency consumers rely on to make informed decisions about their care, undermine important regulatory protections that safeguard patients’ coverage, and jeopardize the ability of hospitals to provide high-quality, accessible care to all who need it.”
The AHA this week urged the FTC and DOJ antitrust division to investigate drug companies' concerted efforts to impose rebate models within the 340B Drug Pricing Program, saying the actions may violate antitrust laws.
Medical debt lawsuits across Minnesota have surged to the highest level in five years, according to a new analysis by Pew. Lawsuits filed for overall consumer debt, including debt from unpaid medical bills, auto loans and credit cards, are also increasing — not just in Minnesota, but across the country. Some experts say these cases are possibly aided by artificial intelligence, which makes it easier for companies to analyze debt that is piling up and file lawsuits quickly.
Democrats are raising the alarm about a federal pilot program that will use artificial intelligence to authorize whether Medicare patients can get certain kinds of treatment.
Does the 340B program need to be updated? Yes. But it needs to be done carefully, with an appreciation of the nuances of the program, its positive impacts and the misuses that have evolved.