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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. These changes will impact how hospitals approach their contracts and denial strategies.

Hospital 130
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Understanding DRG Codes and Their Impact on Hospitals

EvidenceCare

In our efforts to empower hospital clinicians to provide better care by having real-time transparency to cost and benchmark utilization data, we’ve learned that one of the core code systems that defines modern hospital resource management – Diagnosis-Related Groups (DRG) – is misunderstood or even unknown. What is a DRG?

Hospital 130
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Preparing for CERT Audits and Practicing Compliant Documentation

EvidenceCare

This comprehensive guide provides hospital and revenue cycle leadership with vital insights on preparing for CERT audits and establishing processes for compliant documentation. Hospitals need to be aware of these state-specific rules as well. Think of your documentation as the ironclad defense for your hospital admissions.

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

EvidenceCare

In case you aren’t familiar, the Two-Midnight Rule mandates that a patient’s hospital stay must span at least two midnights to qualify for inpatient status, directly influencing reimbursement rates and compliance requirements. In the MA Final Rule, however, CMS explicitly states that the two-midnight presumption does not apply to MA plans.

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Understanding GMLOS and ALOS

EvidenceCare

These measures play a fundamental role in hospital management, financial planning, and patient care optimization. By understanding and leveraging GMLOS and ALOS, hospital executives can improve operational efficiency and patient outcomes. It is the simplest and most commonly used metric for evaluating patient stays.

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STRONG HF – A Positive Trial that Does Not Help Clinical Medicine

Sensible Medicine

The Trial STRONG-HF studied two treatment strategies after a patient was discharged from the hospital after treatment for heart failure. The primary endpoint (of hospital readmission for HF or death) occurred in 15.2% One group gets extra attention in the hospital than 4 extra visits in the first 6 weeks with a cardiologist.

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CNOs Share Their Hopes (And Fears) for Virtual Nursing

Scrubs

Trinity Health announced it will introduce virtual nursing at its hospitals in Michigan and Ardent Health Services plans to do the same in New Mexico. It can also reduce the workload at the bedside by having remote nurses do admissions, discharges, and answer questions virtually.