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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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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. There can also be state variations with additional regulations regarding documentation and coding requirements that layer on top of federal guidelines.

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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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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. Compliant documentation has also become more challenging. Another issue is “inpatient only” procedures.

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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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A ‘SEET’ at the Table: Managing the Four Drivers of Patient Experience

Walker Info - Patient Experience

Improving Access and Outcomes Using Success, Effort, Emotion, and Trust Metrics A nurse enters a hospital room for a routine blood draw. Hospitals with higher patient experience scores report a 161% better net margin than competitors with low scores. [1] She greets the patient, explains why she is there, and begins the task.

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14 Ways ChatGPT Is Transforming The Future Of Healthcare

Arkenea

Physicians can streamline documentation procedures, and generate medical charts, and discharge instructions. Physicians can streamline the documentation procedures, and generate medical charts, also discharge instructions. ChatGPT has become a global phenomenon, with over 1 million sign-ups to try the chatbot post-launch.