Tag: Healthcare Costs

How a Medicare Out-of-Pocket Cap Could Reshape Healthcare

For millions of Americans relying on Medicare, the specter of high out-of-pocket healthcare costs looms large. Unexpected illnesses, chronic conditions, and even routine medical needs can quickly erode savings and create significant financial strain. The idea of a Medicare out-of-pocket spending cap has long been a topic of discussion, promising a shield against catastrophic expenses. […]
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Medicare reimbursement cuts

Medicare reimbursement cuts and their impact on private practice physicians

Medicare is failing both patients and physicians. After adjusting for inflation, physician reimbursement under Medicare has declined by 33% from 2001 to 2025, according to the American Medical Association. In stark contrast, Medicare payments to hospitals have surged by nearly 60%, while hospital executive salaries have skyrocketed 93% over the past decade. How can private […]
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Prior Authorizations

Prior Authorization in Medicare: What You Need to Know

Prior authorization, the requirement for pre-approval from your insurer for certain services, is a common practice in both Original Medicare and Medicare Advantage (MA) plans. While it helps manage utilization and costs, it can also be frustrating, especially when a request is denied. A 2023 study by health policy research revealed the increasing prevalence of […]
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How AI and Automation are Revolutionizing Payment Integrity in Healthcare

How AI and Automation are Revolutionizing Payment Integrity in Healthcare

Healthcare payment integrity is a crucial aspect of efficient claims processing, and its improvement can significantly reduce costs and improve patient care. Healthcare costs continue to climb, burdening patients, providers, and insurers alike. A significant driver of this issue is the inefficiency of healthcare administration, particularly in claims processing. Despite standardized claim formats, outdated systems […]
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Medicare Advantage denials

Understanding the Rise of Medicare Advantage Denials: What Need to Know

Medicare Advantage (MA) plans, a type of private health insurance, have become increasingly popular among seniors. These plans offer additional benefits beyond traditional Medicare, but they also come with their own set of complexities.  One of the most significant issues faced by MA beneficiaries is Medicare Advantage denials for medical services. Recent data has revealed […]
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Future of Medicare Telehealth is Bright and Innovative

Future of Medicare Telehealth is Bright and Innovative

Medicare, the federal health insurance program for people aged 65 and older, has been at the forefront of healthcare innovation. In recent years, telehealth has emerged as a powerful tool, transforming the way healthcare services are delivered. As technology continues to advance, the future of Medicare telehealth looks increasingly promising. Telehealth: A Brief Overview Telehealth, […]
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Medicare Payment Cuts Hit Physicians: 2.93% Reduction in 2025

Medicare Payment Cuts Hit Physicians: 2.93% Reduction in 2025

Medicare payment cut: The Centers for Medicare & Medicaid Services (CMS) has released its proposed rule for the 2025 Medicare Physician Fee Schedule (MPFS), which includes a 2.93% average payment rate reduction for physicians. This comes despite the agency’s stated commitment to advancing health equity and supporting whole-person care through initiatives like strengthening primary care […]
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How Intelligent Automation Can Address 3 Revenue Cycle Challenges

How Intelligent Automation Can Address 3 Revenue Cycle Challenges

The healthcare industry has long buzzed about the potential of Artificial Intelligence (AI) to revolutionize financial operations and internal workflows. However, for practical solutions tackling the complexities of RCM, intelligent automation offers a more realistic path forward. Why Intelligent Automation Over AI? True AI strives to mimic human cognition, but it remains in its early […]
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Specialty care improves outcomes and reduces costs for CMS

Specialty care improves outcomes and reduces costs for CMS

Streamlining Specialty Care: CMS’s Innovation Center prioritizes strategies that improve personalized healthcare information, implement financial services, and support segment-based classifications. A value-based approach to care must address underlying issues and individualized care to reduce patient outcomes. CMS’s innovation strategy describes ongoing efforts to integrate personalized care into the healthcare system. Previous studies have shown that […]
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Survey: High Initial Claim Denials Impact Healthcare Providers

Survey: High Initial Claim Denials Impact Healthcare Providers

The Rising Denial Rates in Healthcare Claims Processing Initial Claim Denials: In a new survey conducted by healthcare Company an increased percentage of initial claims are denied by private payers, including pre-approvals for medical claims. Hospitals, health systems, and post-acute care providers may have a difficult time getting paid for medical services. The survey respondents […]
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