In this episode of the MGMA Week in Review podcast, hosts Daniel Williams, senior editor at MGMA, and Colleen Luckett, editor and writer at MGMA, discuss the latest healthcare news and trends. They cover the Supreme Court's review of the Affordable Care Act's preventive services mandate, the rise of virtual nursing, and the growing use of AI in healthcare decision-making.

Key Takeaways:

• The Supreme Court has agreed to review a challenge to the ACA's requirement for insurers to cover specific preventive services at no cost, which could limit access to crucial services like cancer screenings and HIV prevention medications.
• Virtual nursing programs are becoming a game-changer in healthcare staffing, with the potential to significantly shift traditional nurse-patient ratios and provide more flexibility for experienced nurses.
• AI tools have surpassed EHR usability as the top tech priority for medical leaders i n 2025, with key goals including automating documentation, improving patient interactions, and enhancing operational efficiency.
• The use of AI by insurance companies to decide which medical treatments to approve is raising concerns, with examples of patients being denied necessary care and the error rates of these systems being as high as 90%.
• A new AI algorithm called RADAR, developed by Linus Health, has shown impressive accuracy in identifying undiagnosed cognitive impairments like Alzheimer's and dementia, potentially transforming value-based care.

Resources Mentioned:

• Axios article on the Supreme Court's review of the ACA's preventive services mandate
• Becker's Hospital Review article on virtual nursing
• MGMA Stat poll on tech priorities for medical leaders in 2025 
• Med City News article on the use of AI by insurance companies
• Healthcare IT News on AI that identifies undiagnosed cognitive impairment 
• MGMA's updated physician fee schedule tool

This episode is brought to you by Zoll Data Systems, software and data solutions for healthcare financial professionals. Zoll AR Boost is the comprehensive automated RCM optimization suite that automatically finds, corrects and verifies patient and payer information to capture more revenue, reduce administrative burden, and improve the patient financial experience. The number one Black Book-rated insurance discovery tool can discover active, billable coverage for more than 40 percent of claims. Visit https://www.zolldata.com/healthcare-financial-data/arboost to learn about the complete Solution suite.