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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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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.” health system.

Follow-Up 149
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AI is Transforming Healthcare Behind the Scenes

Mobius MD

Having AI check errors gives providers peace of mind while speeding up reimbursements and minimizing costly denials. By predicting admissions and discharge patterns, AI helps prevent overcrowding and reduces wait times. Post-visit, AI can guide patients through recovery by sending reminders to take medications or schedule follow-ups.

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Mercer County Joint Township Community Hospital Cyberattack Affects Up to 88,500 Individuals

The HIPAA Journal

Mercer County Joint Township Community Hospital in Coldwater, Ohio, has suffered a significant data breach involving the electronic protected health information of up to 88,541 individuals. Notification letters were mailed to the affected individuals on February 21, 2025.

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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.