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Inpatient vs. Observation: How AI Enhances Utilization Review Processes
Nearly 15% of all healthcare claims submitted to payers for reimbursement are initially denied, with more than half eventually overturned...

Oran Lopez Reed
May 206 min read
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What Are Medical Necessity Denials? A Comprehensive Guide for Hospital RCM Administrators
Nearly three in four healthcare providers report that insurance claim denials have increased between 2022 and 2024, with approximately...

Oran Lopez Reed
May 2012 min read
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How Case Mix Index Affects Contract Negotiations: A Comprehensive Guide for Hospital Administrators
Healthcare providers are experiencing increasing financial pressure, with PwC projecting an 8% year-on-year medical cost trend in 2025...

Oran Lopez Reed
May 810 min read
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The Effects of RAC Audits on Hospitals: Strategies for Success in 2025
According to recent data, Recovery Audit Contractors (RACs) recovered over $2 billion in improper payments in FY 2021 alone, creating a...

Oran Lopez Reed
May 89 min read
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How to Appeal Inpatient Denials at Scale: A Comprehensive Guide for Hospital Administrators
According to Experian Health's 2024 State of Claims report , a staggering 73% of healthcare providers report that claim denials are...

Adi Tantravahi
Apr 256 min read
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Using AI to Identify and Combat DRG Downgrades: A Strategic Approach for Hospital Revenue Protection
Introduction Recent data from the American Hospital Association reveals that between 2022 and 2023, Medicare Advantage claim denials...

Adi Tantravahi
Apr 257 min read
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What You Should Do to Submit Inpatient Appeals Effectively: The Complete Guide
Nearly 15% of all medical claims submitted to private payers and approximately 16% of Medicare Advantage claims were initially denied in...

Adi Tantravahi
Apr 258 min read
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EviCore Turns Up the Dial on Denials: When Profits Drive Healthcare Decisions
ProPublica reveals how EviCore uses AI to deny healthcare claims, transforming patient restrictions into profits.

Adi Tantravahi
Nov 16, 20242 min read
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