@chrissyfarr@RuthReader This is why I always ask founders what their other revenue streams look like if they’re relying on billing one or two new codes. CMS can create a code and scrutinize it just as fast - nothing is guaranteed
Ha! It wouldn’t matter if they did, for the same reason that they can’t: the policies are too vague to explain specific adjudication decisions, and those rules are built by and licensed from payment integrity vendors contracted on contingency from payers to build them. It’s their IP. In most cases we’ve negotiated the payers doesn’t even know what company built them let alone which rule was applied.
Total goat rodeo.
I just had chat with @Mike_Desjadon about why payers can't do this even if they wanted to! Mike, your thoughts....
putting you on the spot :)
https://t.co/eSK4mnuLcJ
Health plans should:
Publish machine-readable medical policies and escalation pathways to allow providers (and AI
tools) to identify requirements before submission. And share clear, published rationales!
Agree so strongly!
https://t.co/TLKnj264mk
Some people survived the darkest chapters of their lives because they had a little animal waiting for them at home. Someone to love, care for, and hold close. Sometimes, having a tiny soul who depends on you is enough to remind you that you still matter, even when life feels unbearable.
So many important points in this PHTI report on AI in healthcare. The administrative section is maddening in how clearly we can track dollars floating down the drain.
Full report: https://t.co/TLKnj26CbS
🚨Direct to Medicare companies are facing increased attention and scrutiny from CMS if the codes aren't being used in the way they're intended.
Compliance is everything.
Read the full analysis from @RuthReader.
https://t.co/fRC4hxlcw9
Pharma has been the center of healthcare innovation for decades.
David Benshoof Klein, founder and CEO of Click Therapeutics thinks that run may be relatively limited if the industry doesn’t embrace technology in a substantial way.
Full episode on Lifers with Christina Farr.
LINKS:
Spotify:
https://t.co/5VGCTdg7pO
Apple:
https://t.co/6s8EuROhtK
YouTube:
https://t.co/9GlEegIuOV
Health plans should:
Publish machine-readable medical policies and escalation pathways to allow providers (and AI
tools) to identify requirements before submission. And share clear, published rationales!
Agree so strongly!
https://t.co/TLKnj264mk
Sitting down to write my next 16-page opus (now you know the topic) & doing it for the premium subs.
Getting deep on carve out strategies, GLP-1 biz models, telehealth reimbursement rates, strategic pivots & so much more.
Lots of chatter in clinical circles about the Schmitt-Thompson protocols, because there's so much call center activity now due to AI. These guidelines have been around since the 1980s, and I'm curious to hear thoughts on whether they should evolve? Or remain just as relevant?
The season 1 *finale* of Rounds goes live Thursday, October 15th at 1pm ET, and this time, mental health is having its moment.
Stephanie and I, as always, start with the latest headlines: CommonSpirit exiting its $1.9B Conifer contract, Waystar exploring a sale, AI drug discovery names on a run, and KKR and Neuberger investing in Datavant alongside New Mountain Capital.
Then we sat down with two CEOs shaping where mental health has been and where it goes next.
Jake Cooper, CEO and Co-Founder of @GrowTherapy_ . Grow has set itself apart from the incumbents, and with a $150M Series D behind it, the next chapter is just getting started. We'll cover how AI is changing the way providers work and why so many people who need care still don't get it.
Jon Cohen, CEO of @talkspace. Talkspace went from SPAC-era struggles to a payor-based model, and now it's part of UHS. We'll cover what that journey looked like and what comes next (hint: it could be an AI therapist).
Watch right here on X, or tune in via LinkedIn, YouTube, Spotify, or Apple Podcasts.
What if AI doesn’t kill the fax machine, but makes it more useful?
@NishHari_ , CEO of Predoc, makes a contrarian case for why AI agents could extend the life of fax and phone workflows in healthcare by making medical record retrieval less labor-intensive.
From chart chasing to fragmented health records, discover why the future of healthcare AI may look different than we expect.
Read the full piece: https://t.co/rjvnU67FEF