The CMS model Wasteful and Inappropriate Service Reduction (WISer) will leverage AI and other enhanced technologies (e.g., machine learning and algorithmic decision logic) to expedite the prior authorization process for these items and services with the goal of reducing inappropriate utilization, lowering spending in Original Medicare, expediting decision making, and easing provider administrative burden. Here’s what you can expect from CMS’ WISeR model for AI-driven prior authorization.

Is there anything providers can do to optimize risk adjustment coding and documentation without putting their own revenue at risk? Fortunately, the answer is yes. Here are six strategies for physician risk adjustment in healthcare.

Ongoing state and federal changes to prior authorization may ease burdens for providers, but streamlining workflows now is crucial.

A recent analysis identified a trend toward higher-acuity billing in primary care offices, and while some of the shift may be due to real changes in patient illness due to aging populations, higher rates of chronic illness, and more complex presentations, it could also indicate a tendency for upcoding in medical billing that translates to higher costs for patients and inflates system-wide spending.

When deciding whether to in-source or outsource medical billing, it's important to be honest with your goals, strengths, and limitations.

In this article, we’ll cover five questions to consider before billing for missed appointments in your medical practice.