VAB RCM

05/17/2026

The clock is ticking on Q-Day, the looming yet unknown date when quantum computing will have the capacity to quickly and easily break the encryption keys that keep most internet communication safe.

Experts have known about the hypothetical risk of Q-Day since the 1990s. But Google recently warned that quantum computers may be able to hack some encrypted systems by 2029 — a timeline that drastically narrows the window to safeguard data that many cybersecurity specialists had previously predicted. The new estimate means that governments, companies and other entities may have far less time to prepare.

The day when a quantum computer can crack commonly used forms of encryption is drawing closer. The world isn’t prepared, experts say.

05/15/2026

UnitedHealthcare (UHC) is the largest health insurer in America, covering more than 29 million people, according to the American Medical Association (1). Unfortunately, as CNBC reported last year, it has also become the "face of America's health insurance frustrations" (2).

The fatal shooting of the company's CEO Brian Thompson in December of 2024 brought to the forefront the intense frustrations people have with UHC. In fact, his death prompted calls for reforms and criticisms of the insurance industry's focus on profits over people.

UnitedHealthcare is taking a big step to make healthcare access easier.

05/13/2026

Billing frustration is concentrated among younger patients.

63% of patients aged 25–34 hit at least one billing problem, vs. just 14% of those 65 and older. 30% of patients aged 25–34 found billing confusing or worse — nearly four times the rate of those 65 and older.

Healthcare

05/04/2026

Key Takeaways CMS 2026 Regulations Medical Billing Changes

Discover how CMS 2026 Regulations will reshape Medical Billing for independent practices, from audits to reimbursement, so you can protect revenue.

05/01/2026

Traditional Medicare prior authorization has entered a new phase through WISeR

The CMS WISeR (Wasteful and Inappropriate Service Reduction) Model came about in 2026 and is especially important because it brings a prior-authorization / pre-payment review logic into parts of Original Medicare, historically much less authorization-heavy than Medicare Advantage. CMS says providers and suppliers in selected regions may submit prior authorization requests for covered model services or go through post-service/pre-payment review. CMS also says the model uses enhanced technologies, including AI and machine learning, combined with clinician review.
KFF (formerly known as Kaiser Family Foundation, a health policy think tank) notes that prior authorization is routine in Medicare Advantage and private insurance but rare in traditional Medicare, and warns that it can create delays, denials, uncertainty, and administrative costs for providers.
Practical implication: for clients in affected specialties and regions, billing companies need a WISeR checklist: covered services, documentation standards, authorization pathway, appeal process, and payer-review tracking.

Wasteful and Inappropriate Service Reduction (WISeR) Model webpage

04/27/2026

As of April 2026, the medical billing / RCM industry is being shaped by a convergence of prior authorization reform, Medicare rule changes, cybersecurity pressure, denial management, AI, and No Surprises Act compliance.

A major current development is the movement toward standardized and electronic prior authorization. On April 24, 2026, that UnitedHealth and CVS Health have standardized data and submission requirements for more than half of their prior authorizations, as part of a broader insurer initiative to reduce delays and administrative burden. This matters directly to billing companies because prior authorization is becoming a front-end revenue-cycle competency, not merely a clinical-office task.

CMS is also pushing electronic prior authorization through its interoperability framework. CMS’s electronic prior authorization page, updated recently, points providers to the 2026 interoperability standards and prior authorization proposals, while CMS’s April 10, 2026 proposal would extend certain interoperability/prior authorization requirements to small-group market QHP issuers on the federally facilitated SHOP marketplace.

Practical implication: billing companies should treat prior authorization as a billable, trackable workflow with payer-specific rules, appeal templates, evidence packets, and turnaround-time monitoring.

US News is a recognized leader in college, grad school, hospital, mutual fund, and car rankings. Track elected officials, research health conditions, and find news you can use in politics, business, health, and education.

04/14/2026

Modern Healthcare just released the 2026 100 Top Hospitals® list. This annual program uses a data-driven methodology to identify the nation's top-performing hospitals, evaluating clinical outcomes, operational efficiency, financial health, and patient experience.

Also recognized is the Everest Award — a special distinction honoring hospitals that have achieved both the fastest rate of improvement and the highest current-year performance on the balanced scorecard over a five-year period.

Congratulations to all the hospitals and their boards, executives, and medical staff who earned a spot on this year's list.

For over 30 years, the 100 Top Hospitals® program has been producing annual, quantitative studies designed to shine a light on the nation's highest performing hospitals and health systems.

04/11/2026

Touchless Revenue Cycle
Healthcare revenue cycle management (RCM) remains one of the most labor-intensive and costly aspects of healthcare delivery. It accounts for 3–4% of a typical health system's net revenue, translating to more than $140 billion annually across U.S. systems. Traditional automation has delivered incremental gains, but persistent challenges such as high claim denial rates (averaging nearly 20%, with up to 60% never appealed), fragmented technology vendors, manual workflows, and rising labor costs continue to strain operations and delay cash flow.

Enter agentic AI, a significant evolution beyond generative AI. While generative AI primarily creates content or offers advisory insights, agentic AI consists of autonomous AI agents that can perceive, reason, plan, make decisions, and execute complex, end-to-end processes with minimal human supervision — essentially acting as a digital coworker. These agents learn from patterns in rules-based tasks, handle interconnected workflows, and operate under human oversight for exceptions, compliance, and refinement. In RCM, this enables a vision of a "touchless revenue cycle": a self-running system where administrative tasks flow seamlessly with little to no manual intervention, from front-end scheduling through mid-cycle documentation and coding to back-end claims and collections.

In their 2026 report, McKinsey points out that agentic AI offers the first credible path to truly tech-enabled RCM by shifting from narrow task automation to holistic workflow ex*****on. Initial deployments often focus on the back end — where processes are highly rules-governed, labor-intensive, and lower-risk — before expanding across the full cycle. Key use cases include:

Accounts receivable follow-up: Automating high-volume claim status monitoring and outreach to reduce labor hours while processing more claims accurately.

Underpayment and denials management: Identifying patterns, assembling appeal documentation, drafting submissions, and improving overturn rates.

Cash posting and collections: Handling routine payments and patient reminders, freeing staff for strategic work.

These applications leverage agentic AI's ability to orchestrate multi-step tasks, integrate with existing systems, and adapt based on outcomes. Over time, interconnected networks of agents could span the entire cycle — eligibility checks, prior authorizations, coding from clinical documentation, and patient billing — creating a more unified, efficient engine.

04/01/2026

More than 400 hospitals across the United States are at high risk of closing or cutting services because of the Medicaid cuts in President Donald Trump’s “big, beautiful bill.” The fallout could make it harder for millions of people to get care and put thousands of health care workers’ jobs at risk as hospitals lose a key source of federal funding. Medicaid covers about a fifth of all hospital spending.

The Medicaid cuts come in phases, with more significant changes, including work requirements, in 2027 and limits on how states raise funds in 2028. Overall, the law is expected to reduce federal Medicaid funding by roughly $1 trillion over the next decade.

“We’re seeing hospitals that are already under severe financial strain having to make decisions about how to stay financially solvent,” said Eileen O’Grady, a researcher in Public Citizen’s Congress Watch division and the report’s author. “That has pretty clear implications for people who live in that community. It also has ripple effects on other hospitals in those communities.”

https://www.citizen.org/article/big-ugly-threat/

03/25/2026

The American Medical Association’s 2026 Physician Survey on Augmented Intelligence has just been released. The results are in from over 1,600 U.S. doctors across every specialty and practice setting, and the message is clear: AI is no longer on the horizon—it’s already transforming day-to-day medicine. Adoption has doubled since 2023, with 81% of physicians now using AI in their practices and incorporating an average of 2.3 different tools. The biggest jump? Nearly 40% are already using AI to summarize medical research and standards of care—up dramatically in just the last year.
Overall sentiment continues to trend positive. Seventy-six percent of physicians say AI gives them a real advantage in caring for patients, especially when it comes to boosting work efficiency and sharpening diagnostic ability. Many also see huge potential for AI to ease burnout by handling clinical and administrative tasks that currently drain their time and energy.
At the same time, doctors are thoughtful about the risks. Patient privacy, the doctor-patient relationship, and the possibility of skill loss (especially among trainees) remain top concerns. Most physicians want strong safety validation, ironclad data privacy protections, and clear liability rules before going all-in. And 92% say they want more hands-on training and to be actively involved in deciding how AI is brought into their own practices.
In short, the survey shows growing optimism paired with a very practical call for responsible, well-supported adoption. AI in healthcare is here—and physicians are ready to help shape it the right way.
https://www.ama-assn.org/system/files/physician-ai-sentiment-report.pdf

03/21/2026

AMA Board Chair Testifies Before Congress on Health Care Affordability and Patient Access
On March 18, 2026, American Medical Association (AMA) Board of Trustees Chair David H. Aizuss, MD, a board-certified ophthalmologist with an independent multispecialty practice in Calabasas, California, testified before the U.S. House Energy and Commerce Subcommittee on Health at a hearing titled “Lowering Health Care Costs for All Americans: An Examination of the U.S. Provider Landscape.”
Representing physicians nationwide, Dr. Aizuss emphasized that health care affordability is inseparable from patient access. When physician practices face unsustainable financial pressures—such as market consolidation, stagnant payments, rising costs, burdensome regulations, and workforce shortages—patients suffer through reduced access, longer wait times, fewer local options, and higher overall costs as care shifts to more expensive hospital settings.
The testimony detailed how increasing consolidation in health insurance and hospital markets limits physician negotiating power, while Medicare physician payments have declined 33 percent when adjusted for inflation since 2001 despite rising practice expenses. Other key challenges include site-of-service payment disparities that favor hospitals, restrictions on physician-owned hospitals, administrative burdens (including prior authorization), potential disruptions to Medicaid and ACA coverage, and growing physician shortages, particularly in rural and underserved areas.
Dr. Aizuss called on Congress to take immediate action to support independent practices, preserve patient choice, and control long-term costs by:

- Establishing a permanent annual inflationary update for Medicare physician payments tied to the Medicare Economic Index (MEI);
- Reforming Medicare’s outdated budget neutrality requirements to prevent recurring arbitrary cuts;
- Overhauling the Merit-based Incentive Payment System (MIPS) to reduce administrative burdens, especially for small, rural, and independent practices;
- Passing H.R. 4002, the Patient Access to Higher Quality Health Care Act, to repeal Affordable Care Act restrictions on physician-owned hospitals and restore competition;
- Streamlining prior authorization processes and other administrative requirements;
- Addressing site-of-service payment differentials that accelerate consolidation;
- Expanding the physician workforce through increased Medicare-supported GME residency slots, rural training programs, Teaching Health Centers, and the National Health Service Corps;
- Ensuring Medicaid reforms preserve patient coverage while improving physician reimbursement (including a payment floor at Medicare rates) and reducing administrative hurdles to sustain participation.

During the hearing, members of both parties expressed bipartisan concern about inadequate Medicare physician reimbursement and its direct impact on the viability of independent practices, patient access, market competition, and overall health care costs. Broader discussions also addressed structural reforms to reduce consolidation, improve price transparency, and ease regulatory burdens on physicians.

AMA Board of Trustees Chair David H. Aizuss, MD, testifies on March 18, 2026, at a hearing before the House Energy and Commerce Subcommittee on Health.