Revenue Cycle Optimized: Medical Necessity Uncovered and the AI Shift Ahead

Medical necessity sits at the intersection of clinical judgment, coverage policy, and payer scrutiny, and on this episode Stuart Newsome, VP of RCM Insights, unpacks what it really means. Joined by Viveka Jagadeesan (Enablement Manager), Lindsey Nelson (Director of Product Marketing), Christina Harkins (Senior Revenue Cycle Manager), and Angie Adams (VP Clinical & Patient Engagement), the group explores Medicare error data, CERT audits, recoupment risk, NCD vs. LCD nuances, and how AI-driven policy intelligence can support medical necessity on both the front and back end of the revenue cycle. Find all of our network podcasts on your favorite podcast platforms and be sure to subscribe and like us. Learn more at www.healthcarenowradio.com/listen

On this episode Fred Goldstein invites Ami Gopalan, Senior Vice President of Strategic Content and Growth Optimization at Precision AQ in a continion of AMCP’s rare disease series with an in-depth look at IgA nephropathy (IgAN), a progressive autoimmune kidney disease that often goes undiagnosed until advanced stages. As a patient living with IgAN, Ami brings both a professional and personal perspective to the discussion as we explore the disease’s silent progression, the burden it places on patients and families, the evolving treatment landscape, and how managed care can better incorporate patient value, clinical guidelines, and emerging evidence to support long-term outcomes. This podcast is supported by an independent medical education grant from Alexion and AstraZeneca Rare Disease. AMCP offers CPE for this podcast through December 31, 2026. For additional information and to claim credit, please visit: The Power of Partnership: Bridging Patients and Payers in IgA Nephropathy Management. Find all of our network podcasts on your favorite podcast platforms and be sure to subscribe and like us. Learn more at www.healthcarenowradio.com/listen

2026 PREDICTIONS SERIES: Jared, Zain & James Hosts Jared Johnson and Zain Ismail wrap up 2025 and the annual Predictions Series with O.G. guest co-host James Gardner. They keep themselves accountable to last year’s predictions and share seven new trends they're watching heading into 2026.  All that, plus the Flava of the Week about the two opposing perspectives of digital health. How did Ryan Howells recently describe the dichotomy of digital health’s current state, and how can we join the side that feels optimistic and energized by the work that’s being done?  Find all of our network podcasts on your favorite podcast platforms and be sure to subscribe and like us. Learn more at www.healthcarenowradio.com/listen/

Rebuilding Research: Lowering Barriers and Rethinking Evidence in Health Innovation On this episode, host Erica Olenski interviews Zeenia Framroze, CEO and Founder of Alethios, a company on a mission to democratize health research. They explore how AI, decentralized models, and smarter evidence generation can solve persistent challenges in clinical trials, including cost, access, and complexity. From shifting away from the traditional pharma model to creating a more participatory approach to research, Zeenia shares what it takes to build a future where better questions lead to better health outcomes. Find all of our network podcasts on your favorite podcast platforms and be sure to subscribe and like us. Learn more at www.healthcarenowradio.com/listen

Context is Everything On this episode host Adam Turinas dives into the Model Context Protocol (MCP). While it sounds technical, understanding MCP is actually a critical business strategy. It acts as the rules of engagement that allow your AI to access the right data, tools, and brand guidelines safely and effectively. He explain why context architecture is going to matter much more than which specific AI model you use and how getting this right is essential for risk management and accuracy in the healthcare industry. If you want to move beyond generic AI outputs to creating a true competitive advantage, this episode breaks down exactly how to do it. Find all of our network podcasts on your favorite podcast platforms and be sure to subscribe and like us. Learn more at www.healthcarenowradio.com/listen

On this episode Daniel continues the clinical service line series with a deep dive into the orthopedic service line. He is joined by Lori Pagan, CEO of Ortho Northeast, a physician-led orthopedic and spine practice in Indiana known for its entrepreneurial approach and strategic partnerships. Together, they explore how orthopedic groups are adapting to industry trends and building stronger physician–hospital partnerships. They highlight strategies for positioning orthopedic groups for long-term growth while enhancing patient outcomes and experience. To stream our Station live 24/7 visit www.HealthcareNOWRadio.com or ask your Smart Device to “….Play Healthcare NOW Radio”. Find all of our network podcasts on your favorite podcast platforms and be sure to subscribe and like us. Learn more at www.healthcarenowradio.com/listen

Host Matt Fisher talks to Naomi Murphy, Senior Vice President of Data Mining and Coordination of Benefits, Cotiviti about background and explanation of coordination of benefits process; distinctions between commercial insurance, Medicare, and Medicaid for COB; purpose of COB process and influence on relationships; how to improve COB process and encourage efficiency. To stream our Station live 24/7 visit www.HealthcareNOWRadio.com or ask your Smart Device to “….Play Healthcare NOW Radio”. Find all of our network podcasts on your favorite podcast platforms and be sure to subscribe and like us. Learn more at www.healthcarenowradio.com/listen

December News You Can Use A Year-End Tour of Healthcare Absurdity - Broken Flux Capacitors, Robots Flying Planes, and Biff Is Running Healthcare A year-end, popcorn-worthy take on the absurdly expensive and dysfunctional drama that is U.S. healthcare; Critical look at the AI hype in healthcare, using a pyramid model that shows simple agentic AI works, while high-level predictive AI is often a wrong, opaque “black box"; A surreal reminder that robots can land planes, yet still can’t reliably explain or predict clinical conditions like sepsis; New Year predictions shift away from AI optimism toward legislative changes that may strip coverage, overwhelm ERs, and turn preventive care into a luxury amid fragmented guidance; The true modern plague: relentless LinkedIn spam and AI-driven scams, somehow more persistent than healthcare collapse itself.

2026 PREDICTIONS SERIES: Jane Sarasohn-Kahn & Amy Heymans Join hosts Jared Johnson and Zain Ismail for their annual Predictions Series with popular returning guests Jane Sarasohn-Kahn and Amy Heymans sharing where they see consumer health heading in the coming months and years, including some pretty big trends that may surprise you. All that, plus the Flava of the Week about CMS’ new ACCESS model. What chronic conditions is it targeting, and could this be a pivotal moment for digital health? Find all of our network podcasts on your favorite podcast platforms and be sure to subscribe and like us. Learn more at www.healthcarenowradio.com/listen/

S1E7: 2025 Cyber Reflections & Predictions for Healthcare in 2026 On this episode Tamer and Steven are joined by Carter Groome, CEO of First Health Advisory, to recap the top cybersecurity challenges and trends of 2025 and share predictions for 2026. They explore the hype around AI and emphasize the need for intentional and transparent adoption of new technologies. The session also highlights the importance of shifting focus from revealing risks to actively reducing them and prioritizing governance and authenticity to address deepfakes, social engineering, and evolving threats. Join them for key insights to help shape smarter cybersecurity strategies in 2026. To stream our Station live 24/7 visit www.HealthcareNOWRadio.com or ask your Smart Device to “….Play Healthcare NOW Radio”. Find all of our network podcasts on your favorite podcast platforms and be sure to subscribe and like us. Learn more at www.healthcarenowradio.com/listen