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Month: June 2025

AI in Healthcare, AI Tools & Technologies, Artificial Intelligence (AI), Applied AI, AI, ML & Data Science

How AI Helped a Payer-Provider Boost RAF Scores and Earn $5M More in Capitation Payments—Without Extra Patient Volume: AI-Driven HCC Coding Optimization in Medicare Advantage: A $5M Annual Uplift in Capitation Payments

🏥 Introduction In Medicare Advantage (MA), accurate risk adjustment via Hierarchical Condition Category (HCC) coding is crucial for proper reimbursement. Errors or omissions in HCC

AI Tools & Technologies, AI in Healthcare, Artificial Intelligence (AI), AI in Marketing & Business Use Cases, Applied AI, AI, ML & Data Science

How AI Helped a California Health System Recover $3.2M from Missed Surgical Charges Without Seeing More Patients: Revenue Recovery Through AI: A California Health System’s $3.2M Breakthrough Without Adding Patient Volume

🏥 Introduction Healthcare revenue leakage is a pervasive issue, particularly in high-complexity areas like surgical billing. A 2022 HFMA report estimated that U.S. hospitals lose

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