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An "AI Arms Race" or Mutual Benefit? Why Payers and Providers Both Want Faster Decisions
In the world of healthcare billing, the relationship between insurance payers and healthcare providers is often described as an "adversarial" one. For years, the prevailing sentiment among providers has been that prior authorization is simply a tool used by insurance companies to delay care or deny payments. On the surface, it looks like a high-stakes "AI arms race"—providers using technology to force approvals while payers use it to automate denials. However, according to D
AI in the Front Office: Making Tasks Obsolete, Not People
In the world of community health, "AI" can sound like a buzzword or something that’s "not quite there yet." But as Jill Steeley pointed out in our recent conversation on The Claim Game , ignoring these tools is a limiting mindset that costs your practice money and, more importantly, burns out your staff. Jill’s perspective is refreshing: the goal of bringing AI into your practice isn't to replace your team with robots. It’s about making tasks obsolete, not people. Where AI Wi
Breaking the Black Box: How Advanced Tech is Modernizing Prior Authorization
Prior authorization is often the healthcare equivalent of trying to convince a cat to take a bath—it’s frustrating, messy, and you usually end up with a few scratches. If you’ve been in the trenches of private practice for more than five minutes, you know the drill. You bill a session or a procedure, and then you wait. You’re stuck in the "bureaucratic abyss," wondering if a human is actually looking at your clinical notes or if your request just fell into a black hole. It’s
Treat by Numbers? The Truth About Measurement-Informed Care
If you’ve been in the therapy world for any length of time, you’ve probably felt the "data dread." It’s that sinking feeling that insurance companies want to turn your deeply personal, clinical work into a series of cold, hard numbers. It feels like they’re trying to turn a masterpiece into a paint-by-numbers kit. We get it. The idea of "Measurement-Informed Care" can feel like a direct threat to your clinical intuition. But as Dr. Dylan Ross shared on a recent episode of The
Introducing the Claim Game Podcast!
Our mission at Practice Solutions has always been to empower providers to focus on patient care by relieving the burden of billing. This...
Exposing the Algorithm: Mental Health Parity in the Spotlight
Recent investigations by ProPublica revealed how UnitedHealth’s algorithms denied mental health care claims, a practice ruled illegal in...
Non-Quantitative Treatment Limitations (NQTLs) and the Mental Health Parity Act: What In-Network Private Practices Need to Know
Navigating insurance as a mental health provider means facing a range of regulations, standards, and limitations—some clearer than...
The Impact on Private Practices as Hospitals and Health Systems Go Out of Network with Medicare Advantage
In recent years, private practices nationwide have witnessed significant changes in healthcare insurance networks, particularly with...
Telehealth Modernization Act of 2024 Explained
The proposed Telehealth Modernization Act of 2024 represents a significant shift in how telehealth services are regulated and reimbursed...
Ghost Networks: What They Mean for Private Practices and Their Clients
The term “ghost network” has been buzzing in healthcare circles, but many people are unfamiliar with what it means or why it’s such a...
