AI Streamlines Prior Authorizations And Billing But Raises Costs: Report
Meanwhile, a proposed rule from CMS would require Medicare Advantage plans to respond to medication prior authorization requests within 24 or 72 hours, depending on urgency.
While artificial intelligence solutions can reduce administrative burden in prior authorizations and billing, organizations are reporting increased transaction volumes and higher costs, according to a new report. The Peterson Health Technology Institute took insights from a January 2026 workshop featuring senior leaders from a spectrum of organizations, ranging from health systems to federal agencies. Leaders discussed ways in which technology and policy can enable AI to reduce administrative costs, accelerate payment cycles and promote high-value care. (Gleeson, 4/13)
Medicare Advantage plans would have to respond to urgent prior authorization requests for medications within 24 hours, and standard requests within 72 hours, under a proposed rule from the Centers for Medicare & Medicaid Services (CMS). Issued Friday, the proposed rule also would require full disclosure of claims denials and appeals outcomes, according to a CMS press release. (Frieden, 4/13)
More news about the high cost of health care —
A federal judge dismissed an Elevance Health subsidiary’s No Surprises Act lawsuit against billing dispute consultant company HaloMD and several California-headquartered providers. Anthem Blue Cross in July 2025 filed suit in the Central District Court of California. The complaint accused HaloMD and the providers of allegedly inappropriately winning higher reimbursements through the No Surprises Act’s independent dispute resolution system. (DeSilva, 4/13)
Persistence in appealing denied health insurance claims resulted in overturned decisions between 30% and 78% percent of the time, when the case reached independent review organizations (IROs), an analysis of completed external appeals showed. (Clark, 4/13)
The hospitals that emerged from the bankruptcies of Steward Health Care System and Prospect Medical Holdings Inc. were supposed to help stabilize one of the world’s largest hospital landlords by restoring a battered tenant base after two years of industry stress. Instead, many are already showing signs of renewed distress. Several hospitals in Florida, California and other states — all important tenants of Medical Properties Trust Inc., the hospital landlord known as MPT — have fallen behind on payments to vendors and other creditors, court filings and other records show. (Biswas, 4/13)
St. John’s Health Board of Trustees is looking at various strategies to keep the Jackson hospital afloat ahead of a fall property tax vote that could decimate its tax income. That’s after an already tough year for rural hospitals, which battled high rates of uncompensated care and delayed federal funding that is expected to shrink from past years. (McMurtry, 4/13)
The Centers for Medicare and Medicaid Services picked 150 digital health companies and healthcare providers to participate in the launch of its tech-enabled chronic care model. The Center for Medicare and Medicaid Innovation (CMMI) announced in December the Advancing Chronic Care with Effective Scalable Solutions (ACCESS) Model as a 10-year payment program to encourage the use of technology to treat chronic diseases. CMS aims for the ACCESS Model to provide stable, recurring payments for technology used to treat diabetes, hypertension, chronic kidney disease, obesity, depression and anxiety. The model will help pay for telehealth software, wearables and wellness apps that address the conditions. (Landi, 4/13)
