Thu.Jan 16, 2025

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What Payers Need to Know to Stay Ahead in 2025

MRO Compliance

2025 has arrived and with it brings new challenges and potential opportunities to the healthcare landscape. Payers face increasing regulatory demands, heightened expectations for interoperability, a renewed focus on payment integrity, and rising pressure to address health equity. These changes can feel daunting, but with the right tools and strategies, payers can thrive, innovate, and build stronger partnerships.

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UnitedHealth reaches record revenue in 2024, though profit falls

Healthcare Dive

UnitedHealth’s net income plummeted to its lowest level since 2019 amid hefty costs, including some from the Change cyberattack. CEO Andrew Witty also remembered slain executive Brian Thompson on a Thursday morning call.

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Setting the bar for digital primary care

Healthcare It News

Enterprise Taxonomy: Operations Maturity Models Core Technologies EHR Digital Health Business Organizational Governance Technology Node settings: Exclude from Accelerate RSS feed

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Digital health funding falls again in 2024: Rock Health

Healthcare Dive

Investors focused their dollars on younger startups, while deal sizes for more established companies declined last year.

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Simplify Screening for Excluded Providers

Every health care provider that accepts federal payments must screen for excluded providers. Use this sample Exclusion Screening Checklist and Compliance Policy to evaluate and improve your organization’s compliance with the law. Payments from Medicare, Medicaid, and TriCare trigger screening requirements that may extend to employees, contractors, volunteers, board members, and network providers.

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Apollo Hospitals to integrate AI copilots and more AI briefs

Healthcare IT News - Telehealth

Apollo Hospitals to adopt AI copilots from Microsoft Apollo Hospitals will be adopting four AI copilots as part of its new collaboration with Microsoft. In a statement, the technology giant said it will help the hospital group develop and implement its AI roadmap, which will focus on expanding Apollo's remote healthcare platform worldwide and building new technology solutions.

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Fierce Healthcare - Untitled Article

Fierce Healthcare

UnitedHealth Group reported $5.5 billion in profit for the fourth quarter of 2024, on par with its haul a year prior. | UnitedHealth Group reported $5.5 billion in profit for the fourth quarter of 2024, on par with its haul a year prior.

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Fierce Healthcare - Untitled Article

Fierce Healthcare

About 44 million people were covered under one of the Affordable Care Act's initiatives, from the insurance marketplaces to Medicaid expansion, according to a new report from KFF.

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Century Health to Curate Real World EHR Data for MS Research and Treatments

HIT Consultant

What You Should Know: – Century Health , a provider in applying artificial intelligence (AI) to real-world data for research acceleration, and Nira Medical , a national leader in neurological care delivery, announced a strategic partnership to advance the understanding of multiple sclerosis (MS) and improve patient outcomes. – The collaboration will leverage Century Health’s AI platform to curate and structure data from over 3,000 MS patients treated within Nira Medical’s

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Fierce Healthcare - Untitled Article

Fierce Healthcare

The cancer mortality rate dropped by 34% from 1991 to 2022. This saved about 4.5 million lives. Still, incidence rates in women between ages 50 and 64 have surpassed men, and rates in women under 50 are 82% higher than in men.

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Life insurance company Guardian teams up with Uber Health

Mobi Health News

Guardian's members with disabilities will receive an Uber voucher for medical appointments.

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Healthcare Vendor Risk Management: Strategies for Protected Data

In healthcare, where patient data protection is paramount, effective vendor risk management isn't just good business—it's essential for maintaining compliance and trust. This comprehensive guide helps healthcare compliance professionals navigate the complexities of third-party vendor relationships in an increasingly interconnected healthcare environment.

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Fierce Healthcare - Untitled Article

Fierce Healthcare

Alignment Healthcare is the latest Medicare Advantage (MA) insurer to accuse the Centers for Medicare & Medicaid Services (CMS) of wrongly calculating the companys star rating scores. | Insurers, perhaps smelling blood in the water, continue to question elements and scoring of the CMS star ratings program in court.

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Hong Kong robotics maker scores $70M Series C funding and more funding briefs

Mobi Health News

Also, Aevice Health from Singapore has obtained new investment for its global expansion.

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Fierce Healthcare - Untitled Article

Fierce Healthcare

Medicare Advantage (MA) insurers Alignment Healthcare and Clover Health both reported increased membership growth ahead of the J.P. Morgan Healthcare Conference this week. | Only Alignment Healthcare and Clover Health represented insurers at the J.P Morgan Healthcare Conference this year. Here's what they had to say.

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Healthcare experts discuss AI oversight and innovation at BCG event

Mobi Health News

At an event outside JPM, which included a representative from HHS, panelists discussed the government's role in advancing AI and the evolving healthcare landscape as a new administration transitions into power.

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Navigating Payroll Compliance: Future-Proofing Payroll in an Evolving Regulatory Landscape

Speaker: Jennifer Hill

Payroll compliance is a cornerstone of business success, yet for small and midsize businesses, it’s becoming increasingly challenging to navigate the ever-evolving landscape of federal, state, and local regulations. Mistakes can lead to costly penalties and operational disruptions, making it essential to adopt advanced solutions that ensure accuracy and efficiency.

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OCR Settles With Northeast Surgical Group, P.C. over Potential HIPAA Risk Analysis Rule Violation

Compliancy Group

In mid-January of 2025, the Department of Health and Human Services Office for Civil Rights announced a $10,000 settlement agreement with Michigan-based Northeast Surgical Group, P.C. (NESG). The agreement requires NESG to submit to two years of OCR monitoring, in the form of a corrective action plan (CAP). NESG agreed to settle allegations of noncompliance with the HIPAA security risk analysis violation.

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Teal Health secures $10M for at-home cervical cancer screening

Mobi Health News

The company will use the funds to accelerate development of its screening device.

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NHS SBS plans healthcare AI solutions framework

Digital Health News

NHS Shared Business Services (NHS SBS) is planning the formation of a new framework agreement for AI solutions in healthcare.

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Fierce Healthcare - Untitled Article

Fierce Healthcare

A new lawsuit from a drug manufacturer, this time by Teva Pharmaceuticals, is challenging CMS on the Inflation Reduction Act's drug price negotiation program.

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The Evolution of Communication in Healthcare Settings

Healthcare communication has evolved from handwritten notes and paper charts to digital tools like EHRs, telemedicine, and AI-powered platforms. This blog explores how these advancements improve patient outcomes, streamline care delivery, and enhance provider collaboration. Learn about the role of mobile health (mHealth) apps, secure messaging, and social media in bridging communication gaps.

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CMS Behavioral Health Billing Guidelines: Simplified for Outpatient Providers

Medisys Compliance

Behavioral health providers play a critical role in addressing mental health challenges, but navigating the complexities of billing can be daunting. The Centers for Medicare & Medicaid Services (CMS) provides comprehensive behavioral health billing guidelines, which can be overwhelming due to their technical nature and breadth. To assist outpatient behavioral health providers, weve extracted the key CMS billing guidelines related to your daily operations, offering a detailed look at the most

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Pushing Forward Healthcare Interoperability Efforts by The Sequoia Project in 2025

Healthcare IT Today

New guidelines for health care privacy and consent, extending data sharing to new types of organizations, ensuring the clinical usability of data, and just lots and lots of growththese are on the agenda of The Sequoia Project in the upcoming year. In this video, CEO Mariann Yeager concisely explains in this interview their recent achievements, how they work with the ONC and other stakeholders on TEFCA and QHINs, and some of their upcoming plans.

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CQC says 500 inspection reports are stuck in IT platform

Digital Health News

The Care Quality Commission (CQC) revealed that it has around 500 reports which are stuck in its IT platform and cannot be retrieved.

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Scripta Insights Secures Series B Funding, Raises $42M Total, Revolutionizing the Way Americans Shop for Prescription Drugs

Healthcare IT Today

$17M Series B Round Led by Aquiline to Fuel Scriptas Growth into Health Plan and Medicare Advantage Markets Consumerism in healthcare is a popular catchphrase, but when it comes to prescription drugs, Americans are lacking the transparency, clinical expertise, and navigation tools needed to make informed decisions. Thats the problem that the AI-powered pharmacy navigation platform, Scripta Insights , is on a mission to solve, starting with the 105 million Americans who are on self-insured plans.

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3 Reasons to Retire Pagers from Healthcare Settings

Let's discuss the trusty pager—an old favorite that’s losing its shine in hospitals and clinics. While once a staple in hospitals and clinics, pagers now present significant limitations that hinder rather than facilitate communication among healthcare professionals. Healthcare professionals are constantly on the move, and they need communication tools that can keep up with their fast-paced lives.

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NHS trust chief exec Richard Mitchell confirmed for Rewired 2025

Digital Health News

Richard Mitchell, chief executive at University Hospitals of Leicester NHS Trust, is the latest speaker announced for Rewired 2025.

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Proprio and LifeHealthcare Expand AI Surgical Guidance in Southeast Asia

HIT Consultant

What You Should Know: – Proprio , the global leader in AI-powered surgical technology, today announced a strategic partnership with LifeHealthcare , a subsidiary of EBOS Group Limited. Through this partnership, LifeHealthcare will serve as the distribution partner of Proprio Paradigm in Australia and New Zealand. –Additional phases of the agreement will expand distribution of the AI surgical guidance system throughout Southeast Asia.

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Now Available: 2025 MIPS Resources

HealthIT Answers

The Centers for Medicare & Medicaid Services has posted new 2025 Merit-based Incentive Payment System (MIPS) resources to the QPP Resource Library. The post Now Available: 2025 MIPS Resources appeared first on Health IT Answers.

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Instrument Processing Essentials: Key Steps for Sterilization and Storage

Total Medical Compliance Resources

Instrument processing is critical to ensure sterility of instruments utilized on patients. There are four steps in processing instruments: cleaning, packaging, sterilization, and storage. This article will focus on the last two steps: sterilization and storage. Earle H. Spaulding. PhD, devised a rationale for disinfection and sterilization of instruments and items.

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The Role of Technology in Remote Patient Monitoring

Remote patient monitoring (RPM) is transforming healthcare by enabling providers to track patient health outside traditional clinical settings. This blog explores the role of technology in RPM, including wearable devices, mobile apps, and connected medical tools that collect and share real-time data. Discover how RPM expands care access, improves outcomes, enhances patient engagement, and reduces costs by shifting from reactive to proactive care.

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The Detrimental Impact of Tech Debt in the Healthcare and Life Sciences Industries

Healthcare IT Today

The following is a guest article by Mindy Herman, Managing Principal, Health & Sciences at Crowe , and Jasmine Fransen, Consulting at Crowe Medical devices are foundational components to providing exceptional patient care and helping healthcare and life sciences organizations achieve amazing feats of discovery, research, and problem-solving to save and improve lives.

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Security Changes in the Wind

HealthIT Answers

By Matt Fisher - On January 6, 2025, the Department of Health and Human Services officially published a notice of proposed rulemaking to modify and update the HIPAA Security Rule. The timing of the proposed rule leaves any sort of immediate action with a lot of uncertainty (changing administrations bring changing priorities and delays). The post Security Changes in the Wind appeared first on Health IT Answers.

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TetraScience & Microsoft Partner to Advance Scientific AI in Biopharma

HIT Consultant

What You Should Know: – TetraScience , a provider of scientific data cloud solutions announced a strategic collaboration with Microsoft to accelerate the adoption of artificial intelligence (AI) in the biopharmaceutical industry. – The strategic partnership combines TetraScience’s Scientific Data and AI Cloud with the power and security of Microsoft Azure , creating a robust platform for scientific organizations to extract valuable insights from their complex experimental data.

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Digital Health Coffee Time Briefing ☕

Digital Health News

Our latest news roundup includes new Beckman Coulter analysers for Croydon Hospital and a digital inclusion initiative for pregnant women.

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15 Modern Use Cases for Enterprise Business Intelligence

Large enterprises face unique challenges in optimizing their Business Intelligence (BI) output due to the sheer scale and complexity of their operations. Unlike smaller organizations, where basic BI features and simple dashboards might suffice, enterprises must manage vast amounts of data from diverse sources. What are the top modern BI use cases for enterprise businesses to help you get a leg up on the competition?