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Navigating Medicare Advantage: Strategies for Hospitals to Tackle Growing Challenges

EvidenceCare

CMS Policy Changes to Reduce Costs Financial pressures are rising as CMS implements the updated Version 28 Hierarchical Condition Category (HCC) model , which introduces changes aimed at limiting types of codes that are most used for up-coding or over-coding to help rein in spending. We call them CMS 4201 violations.

Hospital 130
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New Insights on Medicare Advantage Plans and The Two-Midnight Rule

EvidenceCare

This also means that the medical record must support the reasonableness of the clinician’s admission decision regardless of the total time spent in the facility. Be on the lookout for post discharge audits as the Medicare Advantage plans do not have to follow the two-midnight presumption. Another issue is “inpatient only” procedures.

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Preparing for CERT Audits and Practicing Compliant Documentation

EvidenceCare

From understanding the audit requirements to implementing technology for streamlined admission documentation , this article offers actionable strategies to ensure hospitals are well-prepared for the rigorous evaluation process. Think of your documentation as the ironclad defense for your hospital admissions. As researched by OS Inc.,

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What do the Neighbourhood Health Guidelines mean for Practice Managers?

Practice Index

NHS England states that regional teams should be working with local government partners to set priorities for 2025/26, with an emphasis on improving timely access to general practice, urgent and emergency care, and reducing long and costly admissions to hospitals or care homes.

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Nurses Hacking for Health, Addressing Burnout, Workplace Violence, and AI

Health Populi

Three in four nurses working in hospitals care about the success of their institution — “they show up and gown up…yet only 57% feel a sense of ownership in their hospitals, leaving leaders to expect 100% quality to be delivered by about half of the nursing workforce.”

Follow-Up 150
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Inside Geisinger Med School Admissions with Dr. Michelle Schmude [Episode 600]

Accepted Blog

Show Summary Welcome to the 600th episode of Admissions Straight Talk ! Show Notes Welcome to the 600th episode of Admissions Straight Talk. Accepted’s free guide, Med School Admissions, What You Need to Know to Get Accepted can tell you exactly what you need to do. Dr. Schmude, welcome back to Admission Straight Talk.

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How BPCI Enhances Patient Experience and Lowers Costs: A Comprehensive Guide

Guideway Care

Cost reduction strategies in BPCI focus on linking payment to performance, utilizing predictive analytics and interprofessional collaboration to lower expenses while maintaining high-quality care. At its heart, the BPCI program emphasizes strong collaboration between healthcare providers as essential for enhancing patient experiences.