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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. “Many of our health systems that have at-risk contracts are expecting headwinds in revenue of up to 20%.”

Hospital 130
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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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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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Deep Dive into Duke Medical: An Interview with Dr. Linton Yee, Associate Dean of Admissions [Episode 593]

Accepted Blog

Show Summary Dr. Linton Yee, Associate Dean for Admissions at Duke University School of Medicine joins us to discuss how applicants can earn a spot in this highly competitive program. Show Notes Welcome to the 593rd episode of Admissions Straight Talk. Accepted’s Med School Admissions quiz can give you a quick reality check.

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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. Actual cardiologists performed these visits, which included up-titration of meds, but, also, as Adam correctly notes, patients had MD-level assessments. Here were the results. A: It does not.

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A Story about Surrogate Outcomes

Sensible Medicine

What follows is a preliminary report. The current choice is something called HHF or hospitalization for heart failure. New drugs for heart failure may not reduce death, but if they reduce the need for a hospital admission to treat excess fluid build-up, that is a positive. You can read the whole thing.

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Can We Select “Better” Residents?

Sensible Medicine

If applicants are more impressive on paper, but no more impressive in the clinics and hospitals, aren’t we doing something wrong? To some extent, I think this is mostly what we already do in admission/selection committees. [ii] One could also follow the lead of the tech industry and invest in the selection process.