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Navigating Medicare Advantage: Strategies for Hospitals to Tackle Growing Challenges

EvidenceCare

Written by Carol Howard, VP of Clinical Strategy As Medicare Advantage (MA) continues to grow, hospitals have faced growing challenges in navigating complex policies, payer friction, and financial pressures. Recently, I interviewed industry experts who discussed these issues in depth during a live recording of The Better Care Podcast. The panel featured Jackie Kimmel , Senior Director of Strategy Catalyst for The Health Management Academy , Dr.

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Healthcare Costs Are Devouring The Earnings Of Middle-Class Families

Forbes Healthcare

Many families fail to realize how much they spend on healthcare because they don’t pay out of one pocket—they pay out of four.

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St. Paul Wipes Out $40 Million in Medical Debt for 32,000 Residents

Scrubs

In an unprecedented step toward financial relief and health equity, the city of St. Paul, Minnesota, has announced the erasure of nearly $40 million in medical debt for 32,000 residents. Through a partnership between city and state leaders and medical debt relief organizations, this initiative aims to lift a massive burden off the shoulders of St. Paul residents, allowing them to “breathe easy” and focus on their well-being without the looming stress of unpaid medical bills.

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Billing “Incident to” in Inpatient Facilities

Legal Eye on Medical Assisting

I recently received the following question: In researching the use of medical assistants in the Medicare Chronic Care Management (CCM) program, I came across your excellent talk in 2018 on YouTube.

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If You Sanewashed RFK Jr., Or If You Sanewashed Doctors Who Did, You Own the Next 4 Years

Science Based Medicine

When RFK Jr. does to the U.S. what he did to Samoa, doctors will say they are horrified, that they love vaccines, blah blah blah. But it will be too late. The post If You Sanewashed RFK Jr., Or If You Sanewashed Doctors Who Did, You Own the Next 4 Years first appeared on Science-Based Medicine.

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Outsourcing In Drug Development: A Key Strategy for Sustainable Growth

Electronic Health Reporter

This article is copyrighted strictly for Electronic Health Reporter. Illegal copying is prohibited. The pharmaceutical industry is constantly evolving, driven by advances in science, technology, and patient needs. One of the most prominent trends shaping this industry is the outsourcing of various stages of drug development. As companies […] The article Outsourcing In Drug Development: A Key Strategy for Sustainable Growth appeared first on electronichealthreporter.com.

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What You Should Know About Ovarian Cancer Vaccines

Forbes Healthcare

Ovarian cancer vaccines are under development, but none are ready for primetime. There are no screening tools for ovarian cancer.

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CMS to lower importance of ‘call center’ metric in Medicare Advantage star ratings

Healthcare Dive - Practice Management

Regulators’ assessment of customer support centers has spurred recent lawsuits from UnitedHealthcare, Centene and Humana. But the metric “is going to have a smaller weighting on star ratings moving forward,” the director of Medicare said.

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What Does it Mean to Own the Next 4 Years?

Science Based Medicine

It means pertussis and measles outbreaks will be happening under your watch and you'll be held responsible while your boss is an anti-vaxx crank. Enjoy! The post What Does it Mean to Own the Next 4 Years? first appeared on Science-Based Medicine.

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MDaudit’s 2024 Benchmark Report Reveals a Fivefold Increase in Dollars At-Risk from Payer Audits While Coding-Related Denials Surged by Over 125%

Electronic Health Reporter

This article is copyrighted strictly for Electronic Health Reporter. Illegal copying is prohibited. External audit volume more than doubled in 2024 over 2023-including higher rates of pre-payment audits-and total at-risk dollars increased fivefold to $11.2 million per MDaudit customer, impacting healthcare provider organizations’ cash flow and exposing them […] The article MDaudit’s 2024 Benchmark Report Reveals a Fivefold Increase in Dollars At-Risk from Payer Audits While Coding-Re

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Mental Health Crisis in Miscarriage–an Unrepresented Patient Population

The Healthcare Blog

By TAMARA MANNS I walked into the emergency department already knowing the outcome. In these same rooms I had told women having the same symptoms as me, “I am so sorry, there is nothing we can do for a miscarriage”. I handed them the same box of single ply tissues I was now sobbing into, as I handed them a pen to sign their discharge paperwork. Two weeks after my emergency room discharge, I continued to live life as if nothing happened, returning to work without any healthcare follow-up to addre

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Women Are Deprioritizing Their Healthcare Needs: New Research

Forbes Healthcare

American women are deprioritizing their healthcare needs. To help women reprioritize their healthcare needs, consider Don’t Wait Days or scripts to help support women.

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DEA, HHS issue another extension for telehealth controlled substance prescribing

Healthcare Dive - Practice Management

The third temporary extension, which prolongs the pandemic-era flexibilities through the end of 2025, is a relief for telehealth groups who had raised concerns about access to medications.

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Private equity and publicly traded hospices show lower caregiver satisfaction compared to not-for-profits

Medical Economics

Study shows that ownership model matters when it comes to caregiver satisfaction, and that doctors should know the ownership structure of hospices.

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HTI-2’s Sweeping Scope Means Unrealistic Timelines, Costly Compliance Requirements, and Concerning Changes

Electronic Health Reporter

This article is copyrighted strictly for Electronic Health Reporter. Illegal copying is prohibited. By Stephanie Jamison (Greenway Health) and Leigh Burchell (Altera Digital Health), Chair and Vice Chair, EHR Association Executive Committee, and Greg Thole (Oracle), Chair, EHR Association Certification Workgroup In the lead-up to publication by the […] The article HTI-2’s Sweeping Scope Means Unrealistic Timelines, Costly Compliance Requirements, and Concerning Changes appeared first on el

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Why Practice Managers don’t get sacked (much) – By PM Polly

Practice Index

Bye-bye, Erik Ten Hag. Hello, Ruben Amorim. But for how long? I like a bit of footie; it was enforced on me as a (then) wife and as a mum to my son who wouldn’t go to sleep unless they had the latest kit on. 20 years on and I’m pretty confident about the off-side rule and I have more knowledge than most people…who don’t watch football. Every time I hear about another Football Manager being sacked, it gets me thinking: why don’t Practice Managers get sacked (much)?

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Let The Numbers Speak: Prescription Drug Provisions In The Inflation Reduction Act

Forbes Healthcare

The Inflation Reduction Act is unlikely to generate savings for taxpayers, while disrupting the market and creating perverse incentives for the biopharma industry.

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Aetna launched a copay-only health plan. What could it mean for benefits teams?

Healthcare Dive - Practice Management

The plan requires only copays for medical services and prescription drugs up to the plan member’s out-of-pocket maximum, with no deductibles or coinsurance costs.

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3 tools providers can adopt to boost patient satisfaction and collection rates

Medical Economics

When providers adopt digital tools, they can deliver a better consumer experience that promotes greater patient satisfaction and increases the likelihood of prompt collections.

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Digital Health Adoption is Surging, But So Is Consumer Distrust

Electronic Health Reporter

This article is copyrighted strictly for Electronic Health Reporter. Illegal copying is prohibited. By Dara St. Louis, executive vice president and a founding partner, Reach3 Insights. Many of us know exactly how many steps we’ve taken today. A quick glance at our phone or other fitness tracker makes […] The article Digital Health Adoption is Surging, But So Is Consumer Distrust appeared first on electronichealthreporter.com.

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Medical Acronyms Crossword

Medical Terminology Blog

Medical acronyms are abbreviations that can be spoken as words , usually formed from the first letters of a phrase, such as NATO (North Atlantic Treaty Organization) or AIDS (acquired immune deficiency syndrome). Solve the medical acronym crossword and challenge your knowledge of the terms that form them. Try Other Medical Terminology Crosswords > Reference: Exploring Medical Language 11th ED, Basic Medical Language, 7th ED Like this post?

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300,000 Patients Impacted By Law Firm Data Breach

Forbes Healthcare

The law firm Thompson Coburn LLP and its client, Presbyterian Healthcare Services (PHS), have become the focus of a class-action lawsuit following a significant data b.

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Health systems band together to test and publicly rank top AI models

Healthcare Dive - Practice Management

Mass General Brigham, Emory and other providers will assess different AI models from companies like Google, Microsoft and Amazon.

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Behavioral finance: your mood and your money

KevinMD.com

Dr. Peter Onorato, an accomplished anesthesiologist, found himself at a crossroads. With a lucrative career and a substantial income, he was eager to grow his wealth. Like many high-income earners, Peter believed he could outsmart the market. Despite his wife’s concerns, he decided to invest over $300,000 in a tech startup after several days of Read more… Behavioral finance: your mood and your money originally appeared in KevinMD.com.

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Medical Practice Credit Card Processing: Uncovering Hidden Fees and Optimizing Revenue Structures

Electronic Health Reporter

This article is copyrighted strictly for Electronic Health Reporter. Illegal copying is prohibited. Over the past decade, credit card spending has more than tripled, leading to billions of dollars in processing fees for merchants. Despite the size of this industry, many find its complexities challenging to navigate. Credit […] The article Medical Practice Credit Card Processing: Uncovering Hidden Fees and Optimizing Revenue Structures appeared first on electronichealthreporter.com.

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Safeguarding innovation and access with nuclear medicine policy

Medical Economics

As we prepare for a new Congress in January, it’s essential to ensure legislators and their staff fully understand the implications of nuclear medicine policy shifts on patient care and medical innovation.

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Timing Is Everything: How Our Experiences Become Memories

Forbes Healthcare

Memories are created in a matter of seconds. Researchers now may have begun to uncover how behavioral timescale learning integrates memories across several seconds.

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Offering health insurance is becoming less lucrative

Healthcare Dive - Practice Management

In the third quarter, the seven major publicly traded insurers’ medical loss ratios increased an average of 3.3 percentage points year over year — a major jump in medical costs.

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From Me to We – A Team First Mindset

Emerging RN Leader

By Rose O. Sherman, EdD, RN, NEA-BC, FAAN For years, nurse leaders never thought much about teamwork. It seemed like such a natural part of nursing. Over the past couple of years, nurse managers have seen changes in how many younger nurses view teamwork and collaboration. Consider the story a nurse manager told during a […] The post From Me to We – A Team First Mindset appeared first on Emerging Nurse Leader.

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What kind of a doctor are you?

Sensible Medicine

“What kind of a doctor are you?” “I’m a general internist.” “Like an intern?” Laughing, “Don’t you think I’m too old to be an intern? No, I do general internal medicine, mostly outpatient primary care, but I do some inpatient general medicine as well.” “Oh, so you’re like a GP.” “Sort of… ” Sensible Medicine is a reader-supported publication.

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Can Chat GPT Plus prove its overall effectiveness in health care settings?

Medical Economics

A study suggests that if health care professionals are better trained with AI than its potential to make care more effective could be in the near future.

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