Technology Council
Articles JP Montoya has written for the Forbes Technology Council.
CMS’s new ABA tool kit shows state Medicaid programs what to check in billing: authorizations, hours and documentation. With ABA spending up 421% since 2021, those claims are next for scrutiny.
Indiana’s Medicaid overhaul is a data problem before it is a policy one, and not only in Indiana: most multi-location practices can’t reconcile supervision with billing on demand.
Most ABA practices track new patient volume. Few track how many referrals reach a completed first visit, which is where revenue quietly disappears.
Traditional Medicare went about 30 years without prior authorization. That ended on January 1, 2026, when CMS’s WISeR pilot began in six states, starting with wound care, not therapy.
Payers now use AI to flag and deny claims at scale, while about half of practices still appeal by hand. With per-enrollee Medicaid costs up 16.6%, that gap is bleeding revenue.
The administrative weight lands hardest on specialty clinics: smaller teams, tighter margins, and procedures that demand more documentation and more prior authorizations than primary care.
Six months of implementation, dozens of trainings, then the call: “We’re turning it off.” The usual cause is a mismatch between the tool and how the clinic works.
Forbes Technology Council is a vetted professional organization for senior technology executives. Articles are published on Forbes.com under Forbes' editorial process.
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