News

When the Centers for Medicare & Medicaid Services (CMS) launches its Transforming Episode Accountability Model (TEAM) initiative next year, the aim will be to improve the patient experience by better coordinating care between healthcare providers.

For more than 700 hospitals across the country, it will mean meeting new accountability, cost, outcomes, and quality standards for surgical care.

The Assistant Secretary for Technology Policy (ASTP) and the Office of the National Coordinator for Health Information Technology (ONC) have issued updated enforcement discretion criteria and extended the compliance deadline for several requirements under the Health Data, Technology, and Interoperability (HTI-1) Final Rule.

Health IT developers who were expected to meet certification requirements by January 1, 2026, will now have until the end of February to complete mandated updates.

The rate of payer audits accelerated in 2025, with hospital inpatient and outpatient average denial amounts that increased by 14% and 12%, respectively. Denial volumes were also up overall, led by a nearly fivefold increase in Request for Information (RFI) and medical necessity denials for Medicare Advantage plans. The total at-risk amounts, number of claims and average amount per claim increased by 30% in payer audits.

Denials related to outpatient coding increased by 26%. These trends send a clear signal to providers that successfully navigating today’s complex financial and regulatory landscape requires prioritizing billing compliance, coding integrity, robust denial prevention strategies, and redefining revenue integrity to ensure sustainability.

The Assistant Secretary for Technology Policy and the Office of the National Coordinator for Health Information Technology have announced new enforcement discretion criteria and extended the deadline to comply with certain regulatory requirements under the Health Data, Technology, and Interoperability: Certification Program Updates, Algorithm Transparency, and Information Sharing rule, or HTI-1.

The recent government shutdown caused substantial delays in HIT developers' ability to comply with crucial HTI-1 regulations. Developers, especially smaller ones, faced significant challenges in updating vital components. While ASTP/ONC has delayed the compliance deadline, there is still a ripple effect on compliance requirements for certain provider reimbursement programs.

The rate of payer audits accelerated in 2025, with hospital inpatient and outpatient average denial amounts that increased by 14 and 12 percent, respectively.

Denial volumes were also up overall, led by a nearly fivefold increase in Requests for Information (RFIs) and medical necessity denials for Medicare Advantage (MA) plans. The total at-risk amounts, number of claims, and average amount per claim increased by 30 percent in payor audits. Denials related to outpatient coding increased by 26 percent.

ICD10 Monitor»

Too often, these stories go untold because the plot details are buried in spreadsheets, lost in static reports, or delivered in formats that fail to connect with leadership’s strategic vision.

For revenue cycle management (RCM), billing compliance, health information management (HIM), and revenue integrity teams responsible for protecting and growing revenues, these untold stories highlight the struggle faced in showcasing their value in a way that drives decisions. The good news is that the battle is not insurmountable; raw data can be converted into compelling, executive-ready narratives that highlight the return on investment (ROI) at every stage of the revenue cycle.

ARLINGTON, Va. /  November 20, 2025 / FriskaAi, an innovative healthcare platform and accompanying care management app that uses advanced AI and mobile technology to help individuals manage their health in partnership with their physicians, today announced its first-ever expansion beyond clinical settings with the launch of FriskaAi Chronic Care Management (CCM), a new version designed specifically for consumers.

In late 2023, a multi-hospital health system in the Southeast saw a sudden spike in payer requests for documentation. The compliance team had been running routine retrospective audits, but the pace of incoming denials and takebacks began to outstrip their ability to respond. Within six months, the organization reported more than $11 million in at-risk revenue and a doubling of external audit activity.

Despite their best efforts, the system was playing defense.

In late 2023, a multi-hospital health system in the Southeast saw a sudden spike in payer requests for documentation. The compliance team had been running routine retrospective audits, but the pace of incoming denials and takebacks began to outstrip their ability to respond. Within six months, the organization reported more than $11 million in at-risk revenue and a doubling of external audit activity.

Despite their best efforts, the system was playing defense.

Few in the healthcare industry question the need to modernize the HIPAA Security Rule, the proposed overhaul of which is expected to be finalized in 2026. But even if the final rule is modified to scale back requirements or lengthen timeframes, compliance will be a heavy lift for many physician practices, hospitals, and health systems.

That reality, coupled with the common-sense need for robust security around protected health information (PHI) and other patient data, makes procrastination a compliance strategy that is doomed to fail.

Healthcare revenue cycle management (RCM) is at a breaking point. Escalating claim denials, shrinking reimbursements, and persistent staffing shortages are forcing finance leaders to rethink traditional approaches. With 84% of health system executives identifying denials as a top threat to financial margins, the pressure to optimize RCM processes has never been greater.

While robotic process automation (RPA) bots have streamlined repetitive tasks, their rigid, rule-based nature struggles with the dynamic complexities of modern RCM.

Merger and acquisition (M&A) activity continues at a rapid pace, posing a risk to data integrity. As impacted hospitals and health systems seek to consolidate their operations and technologies, duplicate and crossover records surge.  While these errors present immediate challenges, the longer-term concern lies in maintaining the accuracy and integrity of patient data across newly merged systems.

We sat down with Harris Data Integrity Solutions’ executive vice president, Rachel Podczervinski, MS, RHIA, and director of industry relations, Julie A. Pursley, MSHI, RHIA, CHDA, FAHIMA, for an in-depth exploration of the obstacles confronting those tasked with maintaining the accuracy of patient data in a rapidly consolidating healthcare environment.

Advances in artificial intelligence (AI) and automation have given rise to the next-generation digital workforce in healthcare revenue cycle management (RCM): Agentic AI.

The value of agentic AI, and other forms of digital agents, is not only their ability to accelerate task completion with greater accuracy but also to accomplish judgment and logic-driven tasks usually reserved for humans. Claim follow-ups, denial prevention, eligibility verification, data and payment reconciliation, and patient financial engagement are all high-complexity tasks requiring nuanced human judgment that are ideal for agentic AI. Digital agents also help ease the burden on RCM teams, which are already stretched thinly due to chronic workforce shortages.

The AI Journal»

Wellesley, MA  – October 21, 2025 – MDaudit, an award-winning cloud-based continuous risk monitoring platform for RCM that enables the nation’s premier healthcare organizations to minimize billing risks and maximize revenues, joins the American Health Information Management Association^® (AHIMA) in a dynamic film series that shines a light on the vital work of health information (HI) professionals at the intersection of care, technology, and policy. Health Information: Making Every Patient’s Story Matter showcases how HI professionals safeguard sensitive data, improve patient outcomes, and shape smarter and more connected healthcare systems through a series of short films, expert interviews, and real-world case studies.