Summary:
Health insurers see provider coding practices as one factor in unfavorable cost trends, several companies said during recent earnings calls.
As health insurers grapple with rising medical costs and disappointing financial results, a spotlight is turning to provider coding practices and advanced AI-enabled technologies reshaping the healthcare landscape. With mounting tensions between payers and providers, and investigations looming, the question remains: can these industries find common ground, or are they on a collision course?
Source: Reeling Payers Plan to Increase Scrutiny of Providers’ Coding Practices, Nick Hut, HFMA, July 29, 2025; https://www.hfma.org/revenue-cycle/reeling-payers-plan-to-increase-scrutiny-of-providers-coding-practices/ .
Topics
Payment Models
Financial Management
Environmental Influences
Related
Strengthening Payer Relationships Amid Rising Healthcare CostsHealthcare Executive Highlights for Second Quarter 2025How to Know When to Pursue Your Side Gig Full-TimeRecommended Reading
Strategy and Innovation
Report on a Formalized Case-Based Peer Support Program to Improve Physician Well-being
Strategy and Innovation
Primary Care on the Ropes
Strategy and Innovation
Use AI to Stress Test Your Supply Chain