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CMS-0057 adoption is still in its infancy, but it will define the next wave of healthcare automation. Over the past few months, I’ve noticed a quiet but powerful shift among a handful of forward-thinking providers. They’re not treating CMS-0057 as another compliance checkbox; they’re using it as a blueprint for end-to-end automation. Here’s why this matters: Until now, prior authorization has been a black hole, fragmented, fax-driven, and painfully manual. CMS-0057 changes that by mandating: - Real-time data exchange via FHIR-based APIs - Electronic prior auth (ePA) directly inside EHR workflows - Decision transparency from payers to providers - Interoperable data sharing with patients But the early adopters aren’t stopping there. They’re re-architecting workflows so that: - FHIR PriorAuth API integrates with clinical decision support (CDS Hooks) - Real-Time Benefit Tools (RTBT) connect to formulary and cost data - AI agents pre-screen requests for completeness and medical necessity - Status updates flow bidirectionally between payers, EHRs, and patient apps This is the real promise of CMS-0057,  not just compliance, but automation that saves clinicians hours, reduces denials, and improves patient access. The smartest systems are asking: “How can we turn a regulation into a workflow advantage? And that’s where healthcare automation is quietly being rewritten. #FHIR #CMS0057 #PriorAuthorization #HealthcareAutomation #Interoperability #HealthTech #AIinHealthcare #DigitalHealth #EHRIntegration #Nirmitee Jitendra Choudhary Chetan Mantri

Deloitte Digital and Salesforce Work to Transform Patient Journey With Multi-Agent Approach for Life Sciences With Agentic Patient Services Suite https://lnkd.in/gNDBTkp7

What if you could cut denials processing from 40 days to single digits? AI is making it happen for leading health systems. Learn more here: https://hubs.li/Q03PPlnr0 The numbers tell a compelling story: 75% reduction in processing time, 37% higher success rates on inpatient admission denials, and 25% improvement on DRG downgrades. While payers have deployed sophisticated AI systems to scrutinize claims faster than ever, providers who continue relying on manual processes face a widening capability gap. Banner Health, Houston Methodist, and Legacy Health are already seeing transformational results—recovering more revenue, faster than traditional methods ever allowed. #rcmblog #ai #artificialintelligence #complexrcm #healthcarercm #rcm #revenuecyclemanagement #denialsmanagement #denialsautomation #denialsprevention #deniedclaims #hospitalmargins #hospitalfinance #ml #machinelearning

𝐓𝐫𝐚𝐧𝐬𝐟𝐨𝐫𝐦 𝐘𝐨𝐮𝐫 𝐇𝐞𝐚𝐥𝐭𝐡𝐜𝐚𝐫𝐞 𝐎𝐩𝐞𝐫𝐚𝐭𝐢𝐨𝐧𝐬 𝐰𝐢𝐭𝐡 𝐀𝐈-𝐏𝐨𝐰𝐞𝐫𝐞𝐝 𝐏𝐚𝐭𝐢𝐞𝐧𝐭 𝐌𝐚𝐧𝐚𝐠𝐞𝐦𝐞𝐧𝐭! Paperwork, disconnected systems, and manual data entry shouldn’t slow down healthcare. At Metizsoft, we’re helping healthcare providers shift from administrative chaos to smart, automated workflows — powered by AI and scalable tech. 🏥✨ In our latest case study, we share how our Scalable Patient Management System helped a healthcare provider: 🔹 Simplify appointment scheduling & patient onboarding. 🔹 Integrate ICD-10 & SNOMED-CT standards for accurate medical records. 🔹 Enable seamless data exchange between departments & external systems. 🔹 Improve decision-making with real-time analytics and dashboards. Proven results: ✅ 52% reduction in admin time ✅ 40% faster patient processing ✅ Higher patient satisfaction & better care coordination With automation, interoperability, and analytics, healthcare teams can finally do what matters most — focus on patients, not paperwork. Explore the full case study 👉 https://lnkd.in/dHq5bTNW #HealthcareInnovation #PatientManagement #PatientExperience #PatientCare #DigitalHealth #HealthTech #EHR #HospitalAutomation #AIinHealthcare #HealthcareSoftware #MedicalSoftware #HealthcareAutomation #DigitalCare #ProductEngineering #Metizsoft

PHYSICIANS DONT WANT MORE CLICKS - THEY WANT CLARITY, SPEED AND CLINICAL RELEVANCE. In 2025, the best EHRs don’t just record—they guide, simplify, and connect. But here’s the catch: 71% of doctors say their EHR still takes too much time away from care. And 35% of denials stem from documentation gaps. 🔍 What Physicians Really Want from Their EHR Physicians are asking for EHRs that reduce friction, support clinical reasoning, and integrate seamlessly with billing and payer workflows. The top priorities include: 1. Fewer clicks and faster charting 2. Cleaner encounter data for coding and billing 3. Real-time decision support 4. Integrated prior authorization and eligibility checks 5. Better visibility into patient history and care gaps 📊 Key Stats (2025) 1. 71% of physicians say EHR documentation takes too much time away from patient care 2. Only 28% believe their EHR helps improve clinical decision-making 3. Up to 35% of claim denials stem from incomplete or inaccurate encounter documentation 4. Physician burnout linked to EHR burden costs the U.S. healthcare system $4.6B annually 🧠 Real-World Examples Mayo Clinic redesigned EHR templates to reduce documentation time by 40% in outpatient cardiology IHA’s CMAPSO Checklist helps practices align EHR and RCM tools for cleaner encounter data and better value-based payment readiness Banner Health integrated AI into EHR workflows to flag missing documentation before claims submission 🏥 How RCM & Payer Teams Can Support For RCM Teams: Audit encounter data quality before claims go out Train clinicians on documentation best practices tied to coding and reimbursement Use EHR-integrated prompts to capture HCCs, SDOH, and risk adjustment factors Track metrics: clean claim rate, denial rate, documentation completeness For Payer Teams: Integrate with provider EHRs to streamline prior auth and eligibility Share denial trends to improve documentation at the source Use NLP tools to extract structured data from clinical notes Support value-based care with shared dashboards and care gap alerts Physicians don’t want more features—they want fewer headaches. #EHR #RCM #PayerStrategy #ClinicalDocumentation #PhysicianBurnout #MedicalBilling #HealthTech #ValueBasedCare #LinkedInLearning

When I see medical groups struggling with patient leakage and extended referral wait times — and I see it all the time — it’s a great reminder of why we built ReferralPoint. The way we see it, these aren't just numbers on a dashboard. They represent real patients who need care, and providers who want to deliver that care as quickly and efficiently as possible. What I also see, and what I know from experience, is that these issues can be fixed. The reality is that most medical groups have incredible talent within their networks, but they're not leveraging data to connect patients with the right providers at the right time. They just need a streamlined process — a system that automates everything, end to end. Referral network optimization is one of the few areas where you can simultaneously improve patient outcomes, provider satisfaction, AND financial performance. It's not about choosing between quality and cost, it's about using intelligence to achieve both. It’s where good medicine meets good business, and they live happily ever after. I'd love to get your take on these issues in the comments below. #PhysicianGroup #ProviderGroup #MedicalGroup #ProviderNetworks #ReferralManagement #ReferralNetwork #ValueBasedCare #HealthTech

🚀 CHEND Healthcare Solutions – Redefining RCM Through Innovation & Intelligence! In today’s evolving healthcare landscape, clinics and providers deserve more than just billing support — they deserve a strategic RCM partner built on research, technology, and continuous innovation. At CHEND Healthcare Solutions, we are not just managing revenue — we are building the future of healthcare operations through our dedicated R&D Division. 🔍 Our R&D focus areas: Past: Deep workflow analysis to identify missed opportunities, leakage points, and payer pattern trends. Present: AI-assisted claim validation, coding accuracy, and intelligent dashboards to improve day-to-day outcomes. Future: Predictive analytics, automation bots, and real-time decision engines that help clinics see and solve revenue challenges before they arise. 💼 Our Core Services: ✅ End-to-End RCM Outsourcing – Claims, follow-ups, denials, and AR management. ✅ Certified Coding Support – CPT, ICD, and modifier accuracy from expert coders. ✅ Credentialing Services – Fast provider enrollments, renewals, and CAQH updates. ✅ Data-driven AI Insights – Helping clinics achieve efficiency, transparency, and predictable growth. We empower independent clinics, multi-location therapy centers, and growing provider groups across the U.S. to scale with confidence — powered by research, innovation, and technology. Let’s build the future of healthcare operations together. 💡 Research. Reliability. Revenue. #RCM #HealthcareR&D #RevenueCycleManagement #MedicalBilling #MedicalCoding #Credentialing #AIinHealthcare #HealthcareAutomation #DenialManagement #ClinicGrowth #HealthcareInnovation #HealthcareTechnology #Outsourcing #PredictiveAnalytics #ChendHealthcareSolutions #FutureOfHealthcare #USHealthcare #ClinicExpansion

When innovation is truly helpful, it solves real-world challenges for the people on the front lines. A recent Healthcare Financial Management Association (HFMA) article illustrates this, sharing the story of how Intermountain Health is improving care by embracing AI-powered #clinicaldocumentation. By listening to their clinicians and understanding their workflow, they successfully integrated technology that helps tell a more complete patient story. View the article featuring Sathya Vijayakumar MS, MBA and colleagues. https://lnkd.in/eMpj-yqP

🚀 𝗖𝗹𝗶𝗻𝗶𝗰𝗮𝗹 𝗱𝗲𝗰𝗶𝘀𝗶𝗼𝗻-𝗺𝗮𝗸𝗶𝗻𝗴 𝗷𝘂𝘀𝘁 𝗴𝗼𝘁 𝘀𝗺𝗮𝗿𝘁𝗲𝗿. Our latest case study shows how a multi-facility healthcare provider improved clinical decision accuracy by 78% and reduced diagnostic time by 65% with EHR–CDS integration on Athena. 𝗧𝗵𝗲 𝗰𝗵𝗮𝗹𝗹𝗲𝗻𝗴𝗲? Fragmented data, manual processes, and a lack of real-time decision support were slowing providers down and increasing the risk of errors. 𝗧𝗵𝗲 𝘀𝗼𝗹𝘂𝘁𝗶𝗼𝗻? 𝗔 𝗰𝗼𝗺𝗽𝗿𝗲𝗵𝗲𝗻𝘀𝗶𝘃𝗲 𝗶𝗻𝘁𝗲𝗴𝗿𝗮𝘁𝗶𝗼𝗻 𝗯𝗿𝗶𝗱𝗴𝗲 𝘁𝗵𝗮𝘁:  ✅ Unified EMR systems with Athena EHR  ✅ Delivered real-time medication interaction checks & safety alerts  ✅ Integrated evidence-based guidelines directly into clinical workflows  ✅ Streamlined diagnostics with lab result analysis & interpretation tools The impact speaks volumes: 𝟳𝟮% 𝗳𝗲𝘄𝗲𝗿 𝗺𝗲𝗱𝗶𝗰𝗮𝗹 𝗲𝗿𝗿𝗼𝗿𝘀, 𝗳𝗮𝘀𝘁𝗲𝗿 𝘄𝗼𝗿𝗸𝗳𝗹𝗼𝘄𝘀, 𝗮𝗻𝗱 𝘀𝗮𝗳𝗲𝗿 𝗽𝗮𝘁𝗶𝗲𝗻𝘁 𝗰𝗮𝗿𝗲. 📖 Read the full case study to see how seamless CDS integration is transforming healthcare operations: https://lnkd.in/dDNRrAh9 #HealthcareInnovation #EHRIntegration #ClinicalDecisionSupport #DigitalHealth

INTEROPERABILITY IS NOT JUST A TECH CHALLENGE—IT IS A CLINICAL WORKFLOW IMPERATIVE. In 2025, the ability to exchange data across platforms defines how fast, safe, and coordinated care can be. And for RCM and payer teams, it’s the difference between friction and flow. 🔧 What Interoperability Really Means Healthcare interoperability refers to the seamless exchange and use of patient data across different systems—EHRs, labs, imaging, billing platforms, and payer portals. It enables: 1. Real-time access to clinical data 2, Faster prior authorizations and eligibility checks 3. Reduced duplicate testing and documentation 4. Smarter care coordination across providers 📊 Key Stats (2025) 62% of U.S. hospitals now operate across all four key areas of interoperability: finding, sending, receiving, and integrating patient data 75% of healthcare organizations have adopted cloud or hybrid cloud solutions to support interoperability 3 out of 4 healthcare executives rank interoperability as a top strategic priority $4.53B projected value of the global healthcare interoperability market in 2024 🧠 Real-World Examples Banner Health integrated Epic with payer APIs to automate eligibility checks and reduce manual errors NYU Langone Health uses FHIR-based tools to sync lab results and imaging across departments in real time UnitedHealthcare launched a provider portal with HL7 and FHIR standards to streamline prior auth and documentation exchange 🏥 How RCM & Payer Teams Can Prepare For RCM Teams: 1. Adopt FHIR-enabled billing platforms to sync with payer systems 2. Automate eligibility and benefits checks using real-time APIs 3. Train staff on interoperability workflows to reduce manual rework 4. Track KPIs: claim rejection rates, auth turnaround time, duplicate testing For Payer Teams: 1. Integrate with provider EHRs using HL7 and FHIR standards 2. Use AI to flag missing documentation and auto-request updates 3. Share utilization data to support care coordination and reduce waste 4. Build dashboards for real-time visibility into provider interactions Interoperability isn’t optional—it’s operational. From prior auth delays to duplicate testing, disconnected systems cost time, money, and trust. #Interoperability #RCM #PayerStrategy #FHIR #HL7 #HealthcareIT #MedicalBilling #ClinicalWorkflows #HealthTech #LinkedInLearning