A federal court blocked CMS statistical extrapolation in RADV audits, but provider documentation requirements remain unchanged. AI-powered fraud detection, payment suspensions, and multiple audit programs continue unaffected. Learn what the ruling actually changed, what didn't, and how to prepare during the 6-12 month window before CMS responds. Get your RADV preparedness roadmap and documentation defense strategy.

Clinical documentation improvement AI increases query response rates, reduces denial rates, and optimizes Case Mix Index at scale. Discover how healthcare organizations use machine learning for real-time documentation alerts, predictive denial prevention, and root cause analysis. Get implementation strategies, essential KPIs, and proven tactics to transform your CDI program from reactive chart review to proactive revenue protection.

HFMA 2025 revealed that even leading health systems like UC San Diego Health are missing 47% of mission-critical RCM technologies. Learn what actually works in autonomous coding, denial management, and AI implementation, beyond vendor hype. Discover why development partnerships outperform product purchases, realistic timelines for technology adoption, and actionable strategies for academic, community, and rural hospitals.

Payer AI systems are processing audits 24/7, targeting high-value DRGs like sepsis and respiratory failure. Learn how revenue cycle leaders are fighting back with AI-powered appeal workflows that reduce processing time by 80-90%, increase appeal volume 3-4x, and turn audits into competitive advantages. Discover implementation strategies, key metrics, and ROI frameworks to modernize your denial management program.

Stop losing revenue to inpatient vs. observation status denials. AI-powered utilization review helps hospitals correctly classify patients, reduce claim denials, and cut appeal time from hours to minutes. Learn implementation strategies, key performance metrics, and how leading healthcare organizations use AI to strengthen UR processes, improve documentation, and recover more revenue through successful appeals.

AI-powered claim denials are transforming healthcare, but at what cost? Examine the controversies around automated coverage decisions, alleged high error rates, and the tension between cost management and patient care. Learn about emerging state regulations, provider response strategies using counter-AI, and the broader policy debate over healthcare as market commodity versus public good. What comes next for the industry?

Hospital closures accelerate as facilities struggle to find optimal size. While 432 rural hospitals face closure risk and large systems like Steward collapse under bureaucracy, mid-sized hospitals discover the sweet spot: 100-350 beds with strategic technology investment. Explore how balanced operations, AI-powered revenue cycle management, and community focus create sustainable healthcare delivery models that outperform both extremes.

ProPublica reveals how EviCore uses AI to deny healthcare claims, transforming patient restrictions into profits.