A new Senate Subcommittee report has confirmed what many SNF operators already suspected: major Medicare Advantage (MA) plans are using AI to systematically deny post-acute care -regardless of patient need. UnitedHealth, CVS/Aetna, and Humana, which collectively cover nearly 60% of MA enrollees, have dramatically increased their denial rates for
Why even the best SNFs are bleeding revenue from missed diagnoses, delayed assessments, and outdated tools - and what leading operators are doing differently. Ask any MDS coordinator how their week’s going, and you’ll get the same answer: too many charts, not enough time. In 2025, it’s
The Patient Driven Payment Model (PDPM) significantly changed how skilled nursing facilities (SNFs) receive reimbursements from Medicare, shifting away from volume-based payments towards a value-driven approach that emphasizes patient-specific characteristics. For administrators, clinicians, and financial staff at SNFs, understanding PDPM is crucial for maintaining compliance, ensuring financial viability, and delivering
AI-driven Revenue Cycle Management (RCM) solutions are helping healthcare providers become more efficient, accurate, and profitable. Here, we compare the top five AI-powered RCM automation platforms available in 2025: Nanonets Health, Jorie AI, Thoughtful AI, Droidal, and Charta Health. 1. Nanonets Health Overview: Nanonets Health automates front-end RCM tasks like
Introduction In the ever-evolving world of healthcare revenue cycle management (RCM), automation is no longer optional - it’s essential. But not all automation is created equal. For over a decade, robotic process automation (RPA) has helped RCM teams mimic human keystrokes and clicks to handle repetitive workflows. In 2025,
Introduction Healthcare revenue cycle teams are at a breaking point. Manual eligibility checks. Endless faxing for prior authorizations. Scrubbing claims line-by-line for compliance. It’s a workflow that drains time, burns out staff, and delays payments. But in 2025, artificial intelligence is changing that. AI-powered revenue cycle automation is no
The Minimum Data Set (MDS) is the backbone of skilled nursing facility (SNF) reimbursement under Medicare's Patient-Driven Payment Model (PDPM). Yet, despite advances in technology, many facilities still manage MDS assessments using manual processes - spreadsheets, paper charts, and endless audits. This approach isn't just outdated;
The healthcare industry faces a financial paradox: despite cutting-edge clinical advances, revenue cycle operations remain trapped in workflows designed for a pre-digital era. While physicians deliver state-of-the-art treatment, their financial teams use manual processes that hemorrhage revenue and burn out staff. “Physicians have this inherent misconception that billing is just
Here's the brutal truth: while everyone obsesses over value-based care strategies and population health management, post-acute care providers are hemorrhaging money through archaic revenue cycle processes that belong in the 1990s. I've witnessed firsthand how manual RCM processes are killing post-acute facilities. These organizations spend more
Back in 2019, the PDPM (Patient-Driven Payment Model) fundamentally changed how skilled nursing facilities (SNFs) get reimbursed under Medicare. On the face of it, the new system of reimbursement promised a holistic view of patients (and a lot more revenue for SNFs). Yet, 5+ years later, many facilities continue to
Healthcare's financial bedrock is shifting. While clinical innovation captures headlines, revenue cycle automation has emerged as the dividing line between thriving providers and those facing financial distress. The data speaks volumes: organizations deploying comprehensive revenue cycle automation report 37% faster cash collection, 42% fewer denials, and $13.50
What Is Eligibility Verification and Why It Matters Now Eligibility verification confirms patients' insurance coverage status, benefits, and financial responsibility before service. This foundation of the revenue cycle determines whether services will be covered, at what percentage, and what patients will owe – information that directly impacts your bottom line.