Since its inception, AI in prior auth has only been at work in the commercial healthcare marketplace. Now new innovative approaches that reframe prior auth as a resource instead of a roadblock have come to Medicare via the WISeR model.

The post ‘Prior Authorization’ Has Become a Dirty Word in Healthcare, But it Might Be Medicare’s Smartest Path Forward appeared first on MedCity News.

Polypharmacy is a cost and safety problem that is solvable. The right technology platform can reduce it by identifying risky regimens, route specific “stop/switch/consolidate” opportunities to clinicians, and track whether changes stick through refill and adherence patterns.

The post Chronic Overmedication: The Polypharmacy Waste and Safety Problem appeared first on MedCity News.

CMS Administrator Dr. Mehmet Oz said that Medicaid’s rapid spending growth is unsustainable and criticized state financing tactics that let providers and governments “game” the system for extra federal funds. He said CMS is shifting its fraud strategy to follow the flow of money rather than just individual offenders in an effort to ensure health dollars are used for legitimate care.

The post Dr. Oz Says the Medicaid Program is Complicit in ‘Legalized Money Laundering’ appeared first on MedCity News.

The real issue isn’t one payer, one policy or one bad actor. It’s a deeply fragmented system built on competing incentives, misaligned responsibilities and layers of administrative friction. 

The post Caught in the Middle: Unraveling Payer-Provider Blame in United States Healthcare appeared first on MedCity News.

By prioritizing sustainability-minded and compliant waste management in the workplace, healthcare leaders can advance patient and employee well-being, as well as environmental and fiscally responsible programs.

The post Advancing Patient & Planet Health Through Proper Healthcare Waste Management appeared first on MedCity News.

AI can be a highly effective tool for plans aiming to reduce fraud, waste and abuse, but only if it is combined with investigative intelligence.

The post AI: A Good Tool to Combat Bad Actors in Healthcare appeared first on MedCity News.

With these tools, therapists can reclaim their time, focus on their patients, and deliver the high-quality care that every individual deserves — all while maintaining the financial stability to thrive in their practices. 

The post Therapists vs. Insurance: How AI Could End the Battle Over Mental Health Care appeared first on MedCity News.

By conducting audits, embracing new technologies and switching products, labs can dramatically reduce plastic waste without sacrificing life-saving discoveries.

The post Every Lab Can Go Greener With These Key Steps appeared first on MedCity News.

By being aware of the latest schemes, health plan leaders can ensure their members have appropriate access to care while preventing bad actors from exploiting telehealth policies established during the pandemic.

The post Mental Health Fraud Schemes: How to Protect Your Plan appeared first on MedCity News.

Between the environment and your healthcare organization’s balance sheet, waste is a big deal. These promising strategies can help solve that problem.

The post Five Ways Hospitals Can Reduce Industry Waste (While Recovering Dollars) appeared first on MedCity News.

The organization offers a platform for member hospitals to buy and sell healthcare products and medical equipment with each other.

The post H-Source: The company helping hospitals reduce supply chain waste appeared first on MedCity News.

The post Seven tips for preventing fraud, waste, and abuse in medical practices appeared first on MedCity News.