Medicare and Medicaid Updates for 2025

On December 10, 2024, the Centers for Medicare & Medicaid Services (CMS) published a proposed rule introducing significant policy and technical changes to the Medicare Advantage (MA) Program, Medicare Prescription Drug Benefit Program (Part D), Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly (PACE) for Contract Year 2026.

Wearable Technology

The integration of wearable technology in the healthcare sector has transformed the way health insurance payers assess risk, engage customers, and manage costs. Devices like fitness trackers, smartwatches, and biosensors provide real-time data that helps payers make informed decisions while enhancing customer engagement. Today, we’re exploring the impact of wearable technology on health insurance payers, supported by statistical data, case studies, and comparative analysis of predicted and actual developments.

Data Privacy and Security Concerns with AI System Enhancements

Part 2: Identify & Address Data Privacy and Security Concerns with AI System Enhancements. As healthcare organizations increasingly adopt artificial intelligence (AI) systems, data privacy and security concerns have become paramount.

Overcoming the Challenge of AI Integration with Existing Systems

AI integration into existing legacy systems presents a significant challenge for many healthcare organizations. These legacy systems, often built on outdated frameworks, are not designed to work seamlessly with advanced AI tools, leading to potential disruptions, increased costs, and slower adoption rates.

First Pass Accuracy: How To Avoid Delays & Inefficiencies In Denial Reviews

Boost first pass accuracy in denial reviews with these strategies for healthcare providers. Visit our Insights page to learn more.

5 Strategies To Enhance Utilization Review and Case Management

Discover five innovative strategies to enhance utilization review and case management for better healthcare outcomes.

Best Practices For Navigating State and Federal Turnaround Time (TAT) Requirements

Explore best practices for managing state and federal Turnaround Time (TAT) requirements effectively. Visit our website to learn more.

Member Statement Compliance: Ensuring Clarity, Accuracy, and Transparency

Learn why member statement compliance matters, challenges faced by payers, and key NCQA guidelines for effective member statements.

How Technology is Modernizing the Peer Review Process

Explore how the peer review process is evolving with technology for improved efficiency and accuracy.

Member Statements: Strategies for Enhancing Communication

Enhance communication and ensure compliance with clear member statements using these effective strategies.