A founder’s checklist for evaluating FHIR development partners — real integration experience, cloud delivery, compliance architecture, and what red flags mean you’re about to overpay for a rebuild.
Blog
Written with passion.
EHR-native AI in skilled nursing can now flag authorization gaps before claims are submitted. But the workflow doesn’t end there. What happens when a payer issues a determination, ends coverage mid-stay, or forces an appeal?
In an HHS-OIG review of June 2024 data, Medicare Advantage plans overturned 95% of appealed SNF admission denials, while enrollees and providers appealed 18% of denials. What that gap means for post-acute appeal triage.
Federal deregulation is narrowing AI transparency rules in certified health IT. It doesn’t remove the need to show how an AI-influenced decision was made. What certification, accreditation, and payer contracts actually require in 2026.
SNF admissions leaders make referral decisions in minutes, on an incomplete financial picture, while Medicaid — their primary payer — keeps getting squeezed. Here’s why that’s an architecture problem, not a training problem, and what it would take to fix it without asking facilities to spend money they don’t have. Table of contents The twenty-minute […]
Short answer: CMS-0057-F requires health plans to launch a Prior Authorization API by January 1, 2027. As of WEDI’s most recent survey, a large share of payers are still early in that build, even as many announce broader prior-auth reform. For hospitals — especially rural and critical access hospitals in the Pacific Northwest running on […]