The last time "coding intensity" rose this fast, CMS cut Medicare inpatient rates for everyone. After the move to MS-DRGs in 2008, hospitals got better at documenting and coding under the new system. CMS concluded that case mix had risen without patients getting any sicker. Congress had CMS recoup $11B through across-the-board inpatient rate cuts from 2014 to 2017, and hospitals argue they never got the full 3.9% back. This week BCBSA called out $942M on AI-driven coding intensity. @DrOzCMS said AI will be inflationary in the short term because it makes billing systems work better. When the payers and the regulator describe the same problem in the same week, expect a policy response to follow. The uncomfortable part -- a rate adjustment can't tell the hospital whose AI captured real, documented acuity from the one that drifted. Everyone takes the cut. The health systems that come through it well will be the ones that can show, encounter by encounter, that what they billed is what the record supports. They'll also know which payments are at risk before the payer comes back for them. bit.ly/47nvx6Y

The AI models that actually predict revenue risk and prevent adverse payment outcomes work like very disciplined analysts who never guess. ..

This exemplifies the AI back-and-forth between payers and providers. Payers have been denying and downgrading more aggressively, and providers have responded with AI coding tools. BCBSA now says those tools have pushed inpatient claims into higher-severity DRGs with no change in the care delivered. For years, coders missed conditions that physicians documented but that never made it onto the claim. When an AI tool catches a documented diagnosis a human would have skipped, that's arguably payment the hospital was always owed. Payers will counter this “coding intensity” with increased post-payment takebacks, that will hit months or years after reimbursement. For health systems revenue risk sits in the space between "the hospital coded what was documented" and "the payer doesn't believe the documentation." Coding less won't close that gap. Knowing which encounters a payer is likely to challenge, while there's still time to fix the record, will. fiercehealthcare.com/finance…

Pondering... How will payers respond to the ongoing spike in utilization rates? Will there be a downstream effect -- increasing denial rates at health systems and hospitals? bit.ly/440nQ3j

Join Sift and Penrod at 11am EST on 5/24 for a webinar showing how #revenuecycle leaders generate 8x returns using advanced analytics and machine learning to prioritize denials workflows, prevent denials and manage payer lag. bit.ly/45rT6cR #salesforce #healthtech

Crowe’s May 2023 RCA benchmarking analysis notes that nearly 15% of every dollar billed is subject to scrutiny and challenges, demanding expensive admin efforts. $0.08 of every $1 billed to commercial payers may never be received or could be retracted. bit.ly/3q7yIxh

Health systems are laser-focused on managing denials, but still they persist (and increase). Denials rose to 11% of all claims in 2022, up nearly 8% from 2021, which is 110,000 unpaid claims for an average-sized health system. bit.ly/43kAAkz

Join us for a webinar on May 25th at 11am ET, exploring how leading health systems use actionable analytics and ML to optimize revenue cycle workflows, accelerate payer reimbursement and prevent denials. Register now: bit.ly/41FY2b0

A discussion around providers' struggle with documentation-related denials. These denials, while most often overturned, cause delays in submission and payer processing, meaning delayed cash recovery. bit.ly/3Ml4mQV

We're thrilled to welcome Karen Dillard as the new Executive Director of Sales at Sift Healthcare! With over 25 years of experience in healthcare services and technology sales, Karen brings a wealth of knowledge and expertise to the team. Welcome Karen!

The relationship between a provider and a payer organization rests on proactive communication—like any business relationship does—but what if that relationship seems one-sided? bit.ly/44HZQ60

Exciting news! Jon Looney has joined Sift as Director of Customer Experience & Partnerships. With 20+ years experience in #healthtech and partnership development, Jon will lead our teams to provide the best customer experience and build strong relationships with our partners.

88% of #healthcare organizations are looking to adopt AI tech for the #revenuecycle. Few know where to start. Sift's free Implementation Guide for the Revenue Cycle maps out the essential steps to implementing meaningful #AI tools at your organization: bit.ly/40wsmUR

Sift is hiring! We're looking for an enthusiastic and creative BI Analyst to join our #analytics team. If you know a good fit, send them our way: bit.ly/3mKi8T4 #healthtech

Curious about #revenuecycle leaders using #machinelearning to drive patient financial engagement? Join Sift, @VUMChealth & @StateCollects on Wed., 4/19 at 11am CST for a look at how VUMC is leverages #ML to deliver individualized payment plans to patients. bit.ly/3GU0qDl

Need lunch plans for tomorrow? Join Sift on this sure-to-be thought-provoking @BeckersHR webinar around the ups, downs, use cases and best practices for using #AI in the #revenuecycle - Wed., April 12th | 12:00 PM CT bit.ly/3nTyfh9

#Healthcare providers are doing their best to manage their data and follow ever-changing rules, but at the end of the day, they're still just at the mercy of payers. bit.ly/3z8CpEi

There is a growing value (and necessity) in proactively offering patients flexible payment arrangements. To do this well, health systems need advanced patient payments analytics, segmentation and workflow optimizations. bit.ly/3Z9GDGd

78% of health system leaders are looking to AI to help with revenue cycle management processes. bit.ly/3n2aCCP

But what if health systems had a proactive view on payer reimbursement trends, #ML to flag likely denials before claims are created, and intelligent denials prioritization tools? (Sift levels the playing field for #healthcare providers) bit.ly/3Z9tf5W