{"id":22366,"date":"2023-06-19T09:00:16","date_gmt":"2023-06-19T09:00:16","guid":{"rendered":"https:\/\/imatsolutions.com\/\/?p=22366"},"modified":"2025-11-03T17:44:28","modified_gmt":"2025-11-03T17:44:28","slug":"health-data-news-roundup-155","status":"publish","type":"post","link":"https:\/\/imatsolutions.com\/index.php\/2023\/06\/health-data-news-roundup-155\/","title":{"rendered":"Health Data News Roundup: AI Effectiveness Comes Down to Quality Data; AI Oversight Needed; and Medicare Advantage Overpayments"},"content":{"rendered":"<p><em>Welcome to the Health Data Weekly News Roundup from IMAT Solutions. As the power of data continues to grow in the healthcare arena, today\u2019s care organizations need to be on the forefront of all news and trends to help ensure that their data analytics efforts deliver accountable and informed care. Each week, we will provide you with the actionable news you need to meet these goals. <\/em><\/p>\n<p><a href=\"https:\/\/imatsolutions.com\/\/index.php\/2023\/06\/the-effectiveness-of-ai-guidance-for-health-systems-is-directly-dependent-on-the-quality-of-the-data\/\"><strong>The Effectiveness of AI Guidance for Health Systems is Directly Dependent on the Quality of the Data<\/strong><\/a><br \/>\nWe recently published an <a href=\"https:\/\/imatsolutions.com\/\/index.php\/2023\/06\/the-effectiveness-of-ai-guidance-for-health-systems-is-directly-dependent-on-the-quality-of-the-data\/\">IMAT blog post<\/a> about how the effectiveness of AI solutions for health systems and payers comes down to having and accessing quality data in the first place.<\/p>\n<p><a href=\"https:\/\/www.ama-assn.org\/practice-management\/prior-authorization\/oversight-needed-payers-use-ai-prior-authorization\" target=\"_blank\" rel=\"noopener\"><strong>Oversight Needed on Payers\u2019 Use of AI in Prior Authorization<\/strong><\/a><br \/>\nAs health insurance companies turn to AI to speed up patient claim and prior-authorization decisions, the AMA is advocating for greater regulatory oversight of the practice, as highlighted in this recent <a href=\"https:\/\/www.ama-assn.org\/practice-management\/prior-authorization\/oversight-needed-payers-use-ai-prior-authorization\" target=\"_blank\" rel=\"noopener\">AMA article<\/a>. <\/p>\n<p><a href=\"https:\/\/www.fiercehealthcare.com\/payers\/medicare-advantage-overpayments-could-top-75b-year-study\" target=\"_blank\" rel=\"noopener\"><strong>Medicare Advantage Overpayments Could Top $75 Billion this Year: Study<\/strong><\/a><br \/>\nResearchers at the University of Southern (USC) California Schaeffer Center for Health Policy and Economics <a href=\"https:\/\/www.fiercehealthcare.com\/payers\/medicare-advantage-overpayments-could-top-75b-year-study\" target=\"_blank\" rel=\"noopener\">estimate<\/a> that overpayments in MA could top $75 billion in 2023, or 20 percent.<\/p>\n<p><a href=\"https:\/\/healthpayerintelligence.com\/news\/health-plans-must-continue-covering-preventive-care-services\" target=\"_blank\" rel=\"noopener\"><strong>Health Plans Must Continue Covering Preventive Care Services<\/strong><\/a><br \/>\nA federal appeals court <a href=\"https:\/\/healthpayerintelligence.com\/news\/health-plans-must-continue-covering-preventive-care-services\" target=\"_blank\" rel=\"noopener\">approved an agreement<\/a> preserving the mandate requiring health plans to cover preventive care services based on recommendations from the US Preventive Services Task Force (USPSTF).<\/p>\n<p><a href=\"https:\/\/healthpayerintelligence.com\/news\/rising-enrollment-higher-costs-spur-medicare-spending-growth\" target=\"_blank\" rel=\"noopener\"><strong>Rising Enrollment, Higher Costs Spur Medicare Spending Growth<\/strong><\/a><br \/>\nRising Medicare enrollment and higher healthcare costs have contributed to significant growth in Medicare spending over the last two decades, according to <a href=\"https:\/\/healthpayerintelligence.com\/news\/rising-enrollment-higher-costs-spur-medicare-spending-growth\" target=\"_blank\" rel=\"noopener\">data from KFF<\/a>.<\/p>\n<p><a href=\"https:\/\/healthpayerintelligence.com\/news\/ahip-how-to-promote-provider-competition-lower-healthcare-spending\" target=\"_blank\" rel=\"noopener\"><strong>AHIP Urges 4 Types of Policies to Reduce Healthcare Spending<\/strong><\/a><br \/>\nAHIP offered <a href=\"https:\/\/healthpayerintelligence.com\/news\/ahip-how-to-promote-provider-competition-lower-healthcare-spending\" target=\"_blank\" rel=\"noopener\">four recommendations<\/a> to the Senate Finance Committee on Consolidation and Competition (the Committee) to support healthy competition and lower healthcare spending in the healthcare industry.<\/p>\n<p><a href=\"https:\/\/www.beckerspayer.com\/payer\/lawmakers-concerned-ai-gives-payers-new-ways-to-deny-care.html\" target=\"_blank\" rel=\"noopener\"><strong>Federal Lawmakers Concerned AI Gives Payers &#8216;New Ways to Deny Care&#8217;<\/strong><\/a><br \/>\nFederal lawmakers are continuing to <a href=\"https:\/\/www.beckerspayer.com\/payer\/lawmakers-concerned-ai-gives-payers-new-ways-to-deny-care.html\" target=\"_blank\" rel=\"noopener\">raise concerns<\/a> about insurers&#8217; use of algorithms and AI to approve or deny claims.  Sen. Ron Wyden, an Oregon Democrat, said he is &#8220;increasingly concerned by the potential for abuse when it comes to the use of big data and algorithms in healthcare.&#8221;<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Welcome to the Health Data Weekly News Roundup from IMAT Solutions. As the power of data continues to grow in the healthcare arena, today\u2019s care organizations need to be on the forefront of all news and trends to help ensure that their data analytics efforts deliver accountable and informed care. Each week, we will provide you with the actionable news you need to meet these goals. The Effectiveness of AI Guidance for Health Systems is&#8230;<\/p>\n","protected":false},"author":8,"featured_media":22368,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[265],"tags":[],"class_list":["post-22366","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-health-data-news"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.7 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Health Data News Roundup: AI Effectiveness Comes Down to Quality Data; AI Oversight Needed; and Medicare Advantage Overpayments - IMAT Solutions<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/imatsolutions.com\/index.php\/2023\/06\/health-data-news-roundup-155\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Health Data News Roundup: AI Effectiveness Comes Down to Quality Data; AI Oversight Needed; and Medicare Advantage Overpayments - IMAT Solutions\" \/>\n<meta property=\"og:description\" content=\"Welcome to the Health Data Weekly News Roundup from IMAT Solutions. 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