In this podcast, Tim explores how deeply embedded incentives, inefficiencies, and subjectivity in the current claims adjudication process create opportunities for manipulation and inefficiency.
Traditionally, payers have cast wide nets and asked providers to navigate hurdles only to claw back money after a payment has been made.
Most payers struggle to incorporate legislative, coding, and clinical changes into policy as well as to validate that policies are consistently applied to make timely, accurate payments of claims.
Translating clinical guidelines into AI-compatible formats requires understanding the guideline's intent and how AI applies rules at scale.
Artificial Intelligence (AI) is often hailed as the savior of healthcare, but can it really handle modern medicine? Here are three big reasons AI might stumble before it soars.
Healthcare is now facing its own innovator’s dilemma. Can the healthcare industry adapt or will it continue to cling to fax machines?
Explore how the new Physicians Make Decisions Act (PMDA) is reshaping conversations around liability, ethical boundaries, and the integration of AI into clinical practice.
Understanding the root causes of provider abrasion is crucial for improving relationships between providers and health plans.
What is AI best suited for? Hearing examples of when to never use AI in healthcare may not be exactly what you were expecting.
With a lack of standardized criteria for identifying codes, there’s a disconnect between providers and payers, resulting in upcoding errors.