Reimbursement

As AI technology continues to evolve, Abhinav Shashank, Innovaccer CEO, says IT leaders must stay focused on ensuring that all AI tools are ethically trained, tested and deployed and that their desired outcomes are clearly defined.

When it comes to claims review, AI allows things to be done much faster than humans with less errors, says Christine Stetler, AVP of Solution Engineering at MedeAnalytics.

Call centers are revenue-generating tools for healthcare facilities, rather than expense centers. AI can be used for workforce management to project volume fluctuations, says Yuriy Kotlyar, cofounder and CEO of American Health Connection.  

Attorney Everett Wilson, managing partner at Polsinelli's Miami office, discusses overall changes in Medicare and Medicare Advantage - and how the recent benefits changes affect consumers, payers and plans.

Dr. Traci Granston, VP of clinical strategy at Cohere Health, discusses intelligent prior authorization using AI to speed up the approval process and how it helps providers receive payment more quickly.

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.