Managing routine radiology does not require the administrative burden of prior authorization. Instead, health plans can implement post-service, pre-payment automated management based on clinical guidelines.

The post Managing Routine Radiology: An Opportunity to Control Costs and Improve Care appeared first on MedCity News.

Monarch, which launched Tuesday, provides the support and technology to help women’s health providers create their own independent practices.

The post Startup Launches to Help Women’s Health Providers Build Independent Practices appeared first on MedCity News.

By reimagining the payment experience through transparency, flexibility, and technology, providers can drive better outcomes for both their bottom line and the patients they serve.

The post Improving Patient Payment Collections: Strategies for Success appeared first on MedCity News.

The Trump administration has cancelled $766 million in contracts to develop mRNA vaccines against potential pandemic flu viruses. In addition, since President Donald Trump took office, at least half of the security council’s staff have been laid off or left. This is dangerous say former health security officials.

The post In Axing mRNA Contract, Trump Delivers Another Blow to US Biosecurity, Former Officials Say appeared first on MedCity News.

Ardent Health is deploying virtual nurse technology to ease workflow burdens on bedside nurses by offloading routine tasks — and its nurse turnover rate has dropped from 15.5% to 9.5%. The health system is also using virtual specialty consults to enhance care in rural hospitals, cutting unnecessary transfers by 85% and enabling more patients to receive quality care close to home.

The post Virtual Nursing Saves Hospitals Money on Turnover Costs, Ardent Health CMO Says appeared first on MedCity News.

President Trump’s plan to fix IVF might look bold in a headline. In reality, it doesn’t create a single new embryology lab. It doesn’t hire one more specialist. It won’t change the fact that right now, only people with plenty of money can afford IVF, and throwing subsidies at a market that’s already bottlenecked only shifts who pays.

The post Making Insurance Cover IVF Could Actually Reduce Access appeared first on MedCity News.

Hospitals saw improved financial performance during the first four months of the year, with operating margins rising to 3.3% thanks to higher patient volumes and more efficient throughput. However, experts warn that hospitals remain financially vulnerable as non-labor expenses continue to rise.

The post Hospitals See Financial Gains Due to Higher Volumes & Improved Throughput appeared first on MedCity News.

Pear Suite recently won the payer/provider technology track of MedCity News’ INVEST Pitch Perfect contest. The startup provides a software platform for community health workers that helps them share data, submit claims and maintain compliance.

The post INVEST Pitch Perfect Spotlight: How Pear Suite Makes Sure Community Health Workers Get Paid appeared first on MedCity News.

[Sponsored] Provider data issues start at enrollment and continue throughout the provider lifecycle, impacting everything from credentialing to the provider directory. ProviderTrust’s new guide explores this topic.

The post Healthcare’s Provider Data Challenges appeared first on MedCity News.

If enacted, the GOP’s spending bill could kick more than 10 million Americans off Medicaid. Experts are worried about the major spike in uncompensated care that hospitals would have to provide — and they’re warning that this change will result in major revenue losses for hospitals, facility closures, higher premiums for commercially insured patients, and worse public health.

The post The GOP’s Budget Plan Is a Crisis in the Making for Hospitals appeared first on MedCity News.

The combination of coverage awareness and care navigation powered by agentic AI has the potential to transform how older adults engage with the healthcare system.

The post The Age of Action: Seizing CMS’s Call to Reimagine Medicare appeared first on MedCity News.

Heranova Lifesciences recently launched a noninvasive blood test to diagnose endometriosis. The standard diagnostic method is laparoscopy, which requires anesthesia, followed by histological confirmation. With its blood test, Heranova seeks to replace the diagnostic function of laparoscopy, thus reserving surgical intervention only for therapeutic purposes.

The post How One Startup Is Aiming to Replace Surgery with Its Endometriosis Diagnostic appeared first on MedCity News.

About six months after rolling out voice AI in its call centers, Allina Health is already seeing signs that the tool is doing a good job of improving the patient experience. The technology is reducing patients’ average call times by 5-10 seconds, and 80% of calls are now answered in 45 seconds or less.

The post Allina Health Sees Early Success From Voice AI in Call Centers appeared first on MedCity News.

What if the kind of cuts we should be talking about are the ones that actually make care better? Like cutting confusion. Because for many people, the biggest barrier to healthcare access isn’t cost or availability – it’s complexity.

The post A Call for Healthcare Cuts — But Not the Kind You’re Thinking Of appeared first on MedCity News.

May has seen a slew of executive hires, exits and layoffs across the healthcare industry. For example, the American Medical Association and TigerConnect named new CEOs, and Google and UnitedHealth Group have seen key executives leave their roles. There were also layoffs at organizations including Devoted Health and New York-Presbyterian.

The post Healthcare Moves: A Monthly Summary of Hires, Exits and Layoffs appeared first on MedCity News.

Sanford Health has expanded its virtual care strategy to improve access for rural patients while also supporting better physician training and retention. By combining tech with a new virtual care center, the health system is seeking to deliver more consistent care and address workforce shortages across the Midwest.

The post Why Sanford Health Is All-In on Virtual Care appeared first on MedCity News.

As speculation about whether Medicaid cuts will be part of the solution to our national debt problem continues, no one can predict how much the Medicaid rollback will be, or its impact on the one in five Americans who rely on it. 

The post When Medicaid Cost Cutting Is Simply Cost Shifting appeared first on MedCity News.

The current prior authorization process in U.S. healthcare constitutes a crisis, according to Jesse Ehrenfeld, immediate past president of the American Medical Association. Prior authorization is wasting clinicians’ time, delaying care and deepening public distrust — yet, payers show little urgency in fixing this problem, he said.

The post Why One Leader Is Calling Out Insurers’ Inaction on Prior Authorization appeared first on MedCity News.

Artificial intelligence is being incorporated into more places in healthcare, for uses such as guiding clinical trial enrollment as well as helping physicians get up to speed on a patient’s history. A panel discussed these applications and more during MedCity News’s INVEST conference in Chicago.

The post AI Is Finding Broader Use in Healthcare, and It’s Not Just for Speedy Drug R&D Anymore appeared first on MedCity News.

In this episode of the MedCity Pivot Podcast, editor-in-chief Arundhati Parmar, speaks with Helix CEO James Lu about his company and how far precision medicine has come.

The post MedCity Pivot Podcast: Precision Medicine with the CEO of Helix appeared first on MedCity News.

Inaccurate provider data is creating a hidden crisis in healthcare by delaying care and driving up costs for both patients and health plans, according to CAQH CEO Sarah Ahmad. Her organization is working to address the issue by improving how provider data is collected and verified on the front end.

The post Bad Provider Data Is Delaying Care and Driving Up Costs, CAQH CEO Warns appeared first on MedCity News.

While prior authorization has made many headlines over the past year, concurrent review has not. Yet missteps in both processes leave hospitals in danger of not getting paid, which can result in higher costs being passed down to patients. 

The post What is Concurrent Review? appeared first on MedCity News.

As an industry, we can and must do more. To be truly actionable, prices must be easily accessible, understandable, and patients need to be actively engaged to act on that information.

The post Healthcare Price Transparency is More Than Showing a Price Tag appeared first on MedCity News.

Healthcare experts shared key principles that are guiding health system strategy during a panel at MedCity News’ INVEST conference. These leaders believe in flexible, patient-centered engagement strategies, emphasize clinical value as the benchmark for adopting technology, and champion collaboration to scale solutions that deliver proven results.

The post 3 Rules Health Systems Are Living By in 2025 appeared first on MedCity News.

The tools exist today to significantly reduce PA’s burden on our healthcare system, we just need to mobilize and implement them. 

The post A Four-Part Roadmap for Responsible Prior Authorization appeared first on MedCity News.

Providers need a revenue cycle management platform that is more affordable and accurate, said Jeremy Delinsky, CEO of Smarter Technologies, during MedCity News’ INVEST conference. New Mountain Capital formed Smarter Technologies this week by combining three separate platforms it had already acquired.

The post How a New PE-Backed RCM Company Plans to Fix the ‘Transactional Bowels of US Healthcare’ appeared first on MedCity News.

Simplifying payments isn’t just about transactions; it’s about building better relationships and ensuring financial health through protection, payment choice, scale, and integration. 

The post Payments Simplified: The 4 Key Features of Modern Healthcare Payment Platforms appeared first on MedCity News.

To scale clinical AI, vendors must design tools that feel natural and personalized to each doctor — otherwise, clinicians won’t use them, said Heidi Health CEO Tom Kelly. In the crowded AI scribe market, he believes that clinician adoption rates, not flashy integration or deployment speeds, are the true measure of success.

The post How One Startup Is Standing Out in the Crowded AI Scribe Market appeared first on MedCity News.

[Sponsored] In an interview with MedCity News, Smarter Technologies CEO Jeremy Delinsky talked about the newly formed business Smarter Technologies and his ambition to automate hospitals’ revenue management capabilities with AI, which lags 2-5 years behind that of payers.

The post How Smarter AI Strikes Back for Hospitals appeared first on MedCity News.

Ensuring buy-in from end users is critical to hospitals’ AI success. To achieve buy-in, hospitals should start by adopting AI tools that address the problems that physicians and nurses have identified as most important to them, said Rohit Chandra, chief digital officer at Cleveland Clinic.

The post Cleveland Clinic Digital Chief: Pick AI Problems That Clinicians Actually Care About appeared first on MedCity News.