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Navigating Medicare Advantage: Strategies for Hospitals to Tackle Growing Challenges

EvidenceCare

Documentation Challenges and Payer Friction As MA plans focus on profit margins, hospitals are encountering increased payer friction, denials, and administrative burdens, particularly around the CMS Two-Midnight Rule. Document why you believe that. She provides education to physicians to document their internal monologue.

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. This section delves into the specific criteria and expectations set by CERT audits, emphasizing the need for meticulous attention to detail and documentation accuracy.

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

EvidenceCare

Robin Gantea, Executive Director of Utilization Management and Clinical Documentation Integrity from Baptist Health Jacksonville mentioned, “We haven’t seen changes in behavior related to the Two-Midnight Rule. We’re still facing the same types of denials, especially with short stays where payers push back post-discharge.”

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Avoiding the Pitfalls of Involuntary Nursing Home Discharges/Transfers in Missouri

Healthcare Law Insights blog

In certain cases, nursing homes may discharge or transfer a resident even if the resident does not consent to the discharge or transfer – this is known as an “involuntary discharge” or an “involuntary transfer.” In this case, the resident has the right to appeal the involuntary discharge or transfer. 19 CSR 30-82.050(3).

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Insights from Digital Health Leaders at ViVE 2025

EvidenceCare

Dr. Wilcoxs journey into digital health started with a simple observation: patients in the post-anesthesia care unit were experiencing unnecessary delays in discharge, leading to longer hospital stays. The idea of integrating multiple solutions into one seamless experience is something I hadnt seen as much in the past, Wilcox shared.

Hospital 130
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Understanding DRG Codes and Their Impact on Hospitals

EvidenceCare

Note: CMS documents how each ICD-10 code can be either a CC or MCC here. They would submit their charges post-discharge and be reimbursed. This is why Clinical Documentation Improvement (CDI) is so important to ensure documentation accurately reflects a patient’s Severity of Illness (SOI).

Hospital 130
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Connect Care Scheduled Downtime and Spring Upgrade - Thursday March 13, 2025, 00:30-04:30

Connect Care Bytes Blog

PRD SRO (the read-only copy of the production environment) will be available during this outage; PRD SRO is accessible from any computer used for documenting in Connect Care regularly. DURING DOWNTIME Check with Unit Clerk/Charge Nurse to confirm processes for ordering, documentation, and patient movement.