Dispute resolution likely to be more disruptive as a result of new rule
A recently released CMS final rule concerning independent dispute resolution (IDR) mediation likely will cause a further bottleneck of No Surprises Act-based appeals, experts said. In the final rule, the fees were set at $15, down from $115 paid before the proposed rule came out. CMS in its proposed rule had originally set the revised…
Battle of the bots: As payers use AI to drive denials higher, providers fight back
Two fighters face each other in the ring, circling together, assuming there will be a single victor. One, representing the U.S. health insurance industry, has made huge investments in aggressive technology over the past several years to automate claim processing and reviews, making it hard for the other fighter — representing the nation’s healthcare providers…