⚕️Medical Insurance Verification Software

Good Morning! Healthcare affordability has become a growing challenge for Americans, with only 55% able to afford and access prescription drugs and quality healthcare—a six-point drop since 2022.

Its only going to be more concerning going forward. Commercial healthcare costs are projected to increase by 8% in 2025, driven by inflationary pressure, prescription drug spending and behavioral health utilization.

DEEP DIVE
Unlocking Essentials To Medical Insurance Verification Software

• In 2022, 92.1 percent of people, or 304.0 million, had health insurance at some point during the year, representing an increase in the insured rate and number of insured from 2021

• Private health insurance coverage continues to be more prevalent than public coverage, at 65.6 percent and 36.1 percent, respectively.

Traditionally the verification was a manual process where healthcare facilities spent hours on calls with the insurance companies, manually checking coverage details, patient eligibility, and benefits.

Medical insurance verification software automates the process of verifying patients' insurance information before services are rendered. It integrates with EHR systems to streamline workflows, facilitates pre-authorization, and reduces administrative burdens and billing errors.

By providing real-time eligibility checks, it minimizes claim denials and enhances revenue cycle management.

Read the complete guide to developing medical insurance verification software here.

PULSE POINTS
Latest Breakthroughs This Week

Here’s the most important breakthroughs and advancements we spotted in the healthcare technology space this week.

• MedLLM for Patient Portal Messages: A study from NYU Langone Health found that AI-generated patient portal messages are comparable in quality to those written by human clinicians. AI matched humans in accuracy, completeness, and tone but were 9.5% better in understandability, twice as empathetic, and 62% more positive. However, they were 38% longer and used more complex language, with an eighth-grade reading level versus a sixth-grade level for human responses.

• Patient Monitoring: Bon Secours Mercy Health is partnering with Philips to enhance patient monitoring across its 49 hospitals. This collaboration will provide access to Philips' latest scalable monitoring technology, integrating patient data for vital insights. The initiative aims to standardize monitoring, reduce costs with a predictable payment model, and enable reinvestment in further innovations.

• AI for RCM: Thoughtful AI launched the world's first fully human-capable AI Agents for healthcare revenue cycle management (RCM). The new AI Agents—CAM, EVA, and PHIL—handle claims processing, patient eligibility verification, and payment posting. These innovations address traditional challenges in healthcare, such as claim denials and staffing issues, allowing providers to improve productivity and focus on patient care instead of administrative tasks.

• Healthcare M&A: GE HealthCare is acquiring Intelligent Ultrasound Group's clinical AI software business for $51 million. This acquisition will integrate Intelligent Ultrasound's AI technology, which supports OBGYN scans, into GE HealthCare's ultrasound portfolio and add their R&D experts to GE HealthCare's team.

EXPERT SPOTLIGHT
Brandon Shalton: Turning Data Into Information

This week, HealthTech Zen got in touch with Brandon Shalton, a technologist with expertise in solving human problems with application of technology.

1. How do you see the role of technology evolving in patient care over the next decade?

AI integration is on an exploded trajectory to utilize it as a tool to help with scaling. With tuned models, the AI could analyze the medical device results and create a summary for the human practitioner to use in reviewing a patient’s case. This allows the practitioner to spend more of their time with direct interfacing with patients, and saving on prep-time through the use of AI and medical device data collections.

What are the key skills and qualities you believe are essential for a successful CTO in the healthcare tech sector?

Technology is pervasive in healthcare that many times it is about using X or Y to solve Z. All the solutions are going to be similar and be able to solve a problem.

The biggest quality I believe a CTO needs to have, is not about technology savviness, everyone is going to have that, it’s to have empathy and understanding that  patients, practitioners, administrators, etc will use the technology you create to help make someone’s life better. To walk in the provider’s shoes,  to understand what tools they need. It can even be understanding what UI/UX will work best in a given environment.

I have been programming since I was 12 on my first computer, the Sinclair ZX81. Fast forward decades of working on computing systems from mainframes, to miniframes, to Client/Server to Cloud, to mobile, the technology evolves, but the underlying magic of computing is turning data into information, in a way that humans can understand.

The users of  the system must like the tool, trust the tool, rely on the tool to assist with their work. The data bits, that we as technology people capture, store, and process, all get utilized by people who are trying to help other people be better. For that, never losing sight of why we are doing what we are doing, not for technology sake, but for helping to make a difference.

Continue reading here

DECODER
What Is A Software As A Medical Device (SaMD)?

Software as a Medical Device (SaMD) refers to software that performs medical functions on its own, without being part of a hardware device. SaMD is used for various purposes, including diagnosis, monitoring, or treatment of medical conditions.

SaMD must comply with regulatory standards to ensure safety, effectiveness, and data security, similar to traditional medical devices. This involves thorough validation, risk management, and adherence to guidelines set by regulatory bodies.

Read about the applications of SaMD, categories, functionalities and creating a roadmap for developing software as a medical device here.