With the red tape of health insurance already causing frustration for millions of Americans, doctors are helping to shed light on a common industry practice: downcoding. This occurs when insurance ...

In programs with three leading value-based care organizations, including Homeward Health, Zus used AI for both suspecting and recapture to uncover hidden clinical complexity and close risk adjustment ...

Private Medicare Advantage can include more types of coverage than traditional plans, but it doesn't necessarily deliver more ...

New ICD-10 diagnosis code is for patients with history of type 2 diabetes who bring blood sugar levels to a non-diabetic range below 6.5% for at least 3 months.

Pittsburgh-based UPMC is expanding its partnership with Abridge, deploying the company's ambient AI documentation technology across its entire ...

After four years, federal price transparency rules have revealed a meaningful number of prices. But they’ve revealed ...

California lawmakers require insurers to keep more accurate provider directories, but state rules aren’t complete, and "ghost networks" fail patients without much penalty.