How to Choose the Right Claims Rules Engine for Your Healthcare Practice
Did you know claims denials cost U.S. healthcare providers an estimated amount of $262 billion annually? But you can avoid it with a right claims rule engine (CRE). It will catch errors before the claim leaves your practice. This guide will explain everything you need to know before selecting the right claims rules engine based […]
How Pediatric Scribe Improves Documentation Accuracy, Provider Efficiency, and Patient Experience?
A significant portion of the professional life of pediatrics is spent in scribing. Scribing has become one of the most time-consuming jobs for pediatricians. Research shows that physicians spend 2 hours on scribing every day for one hour of patient care. In pediatrics, this challenge is even greater. Visits include children of different age groups. […]
Agentic AI Comes to Healthcare Operations
What “AI Agents” Mean for Coding, Documentation, and RCM Healthcare operations are hitting a breaking point this year. The Healthcare Financial Management Association has reported that initial claim denial rates climbed to nearly to 12% and denials are occurring within seconds because payers have become more advanced in their use of AI. But there is […]
Implementing Predictive Analytics in Healthcare to Improve Care and Outcomes
The future of patient care is predictive analytics in healthcare, which allows healthcare providers to foresee potential health risks and patient needs and meet them before these issues develop. Due to the use of artificial intelligence and machine learning on large amounts of electronic health data, hospitals can predict complications or readmission risks before they […]
Will AI Replace Doctors?
Yes, AI can absolutely handle the “pattern work and repetitive workflows.” It can scan diagnostic reports with impressively high accuracy. It can detect trends and flag patterns on X-rays or MRIs, like fractures, hemorrhages, or cancer lesions. AI can also deliver near-perfect consistency on rule-based tasks like calculating medication doses or checking drug interactions, because […]
How CMS WISeR Is Using AI to Review Prior Authorization and Claims
I have been in revenue cycle management for over 18 years. And honestly it’s the first time Medicare has considered AI to review prior authorization, claims, and coding. But how they are doing it? Through WISeR which stands for Wasteful and Inappropriate Service Reduction. It was launched on January 1, 2026. It is not a […]
Guide to AI in Medical Coding for Healthcare Providers 2026
AI in medical coding reached the production scale in 2025. Health systems are currently processing thousands of charts per week via AI without human coders being involved. Physicians are receiving codes in real-time while seeing patients and revenue cycle teams are seeing denial rates become much more manageable. But 2026 will see regulatory shifts you […]
Everything About AI in Medical Billing for 2026
AI in medical billing is here, and 2026 marks the year when it becomes mandatory for most providers. The Centers for Medicare and Medicaid Services is rolling out new regulations that will fundamentally change how billing works, from AI-powered prior authorizations to strict electronic submission deadlines. The conversation around AI medical billing has also shifted. […]
70% of Health Systems Are Adopting AI Medical Coding This Year, Here’s Why
I’ve spent nearly two decades in revenue cycle management, overseeing operations that process millions of claims annually. Most of that time, I’ve watched vendors pitch “revolutionary” technology that turned out to be minor upgrades with better marketing. But what I’m seeing with AI in medical coding is different. It’s fundamentally changing the economics of how […]
Common DME Billing Errors Every Provider Needs to Know
Durable Medical Equipment (DME) billing is one of the most error‑prone areas in healthcare reimbursement. Small mistakes in billing details can result in DME claim denials, delayed reimbursement, and increased administrative costs. According to industry reports, common issues such as incorrect patient information, coding errors, and missing documentation are major contributors to claim rejections. With […]