What do payer incentives tell us about today's reimbursement and denial environment?

In this episode of Zotec Answers, Ed Gaines, Vice President of Regulatory Affairs and Industry Liaison for Zotec Partners, sits down with Ron Howrigon, President and CEO of Fulcrum Strategies, to break down how health insurance payers are shaping today's reimbursement and denial landscape. Drawing on insider payer strategy, they explore why denial rates are rising, how insurers approach reimbursement policy, and what clinicians can do to respond effectively in an evolving revenue cycle environment.

Check out our previous AI update podcast episode. 

Ed Gaines analyzes the CMS IDR Process PUF data for Q1-Q2 2025 and explains what it means for physician arbitration, payer negotiations, and revenue strategy. Learn how recent Transparency in Coverage (TiC) rule changes are affecting physicians in this episode of Zotec Answers. Read more on the release of the IDR Public Use Files. 

Fact-based summary of the hearings on the A to ZPAC blogIn late January, the House Budget Committee held a hearing on skyrocketing health care costs. To learn more about that hearing, check out this press release. 

Comments are due on February 23, 2026.CMS: List of certified independent dispute resolution entities

Zotec and Microsoft partner to bring intelligent automation to radiology workflows - Read more here.

This episode was recorded and produced just before the Executive Order establishing a federal moratorium on state-level AI regulation was signed (12/11/2025). The order creates a unified federal framework, directs a new AI Litigation Task Force, and ties certain broadband funding eligibility to state compliance. We’ll continue to monitor these developments and share updates as they become available.For more information, refer to the White House Fact Sheet and recent news coverage on the Executive Order. 

Zotec and Microsoft partner to bring intelligent automation to radiology workflows at RSNA 2025 - Read more here. 

White Paper - "Medicare's Anchor is Dragging"MPFS Final Rule SummaryMPFS Final Rule Key Takeaways

In this episode of Zotec Answers, Jennifer Fox and Megan Applegarth explore whether states are taking the lead over Congress in crafting AI regulations. They examine how differing state policies are setting the standard for national regulations and what this means for innovation, technology development, and the responsible use of AI across industries.