Part of my attitude relates to an experience I had. And this was within a single HIS. I wanted to…
The National Association of Accountable Care Organizations analyzes Medicare’s claims database to alert the federal government that 450,000 of its beneficiaries were billed for urinary catheters in 2023 versus the usual 50,000 in previous years, running up $2 billion in suspicious charges.
Virgin Pulse and HealthComp, which merged in November 2023, name the $3 billion business Personify Health.
CMS tells Medicare Advantage insurers that they can use AI and algorithms to assist them in making coverage determinations, but they must make sure that the tools use complete information and they can’t use technology alone to deny hospital admission or downgrade to observation stay.