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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%.”

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Mental Health Crisis in Miscarriage–an Unrepresented Patient Population

The Healthcare Blog

I handed them the same box of single ply tissues I was now sobbing into, as I handed them a pen to sign their discharge paperwork. Two weeks after my emergency room discharge, I continued to live life as if nothing happened, returning to work without any healthcare follow-up to address my emotional burden.

Follow-Up 109
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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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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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What I Read This Week

Sensible Medicine

Safety, tolerability and efficacy of up-titration of guideline-directed medical therapies for acute heart failure (STRONG-HF): a multinational, open-label, randomised, trial I’ve come out pretty strongly against GDMT. The primary endpoint was 180-day readmission to hospital due to heart failure or all-cause death.

Follow-Up 107
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The Craziest Medical Bills

Scrubs

trillion, was spent on hospital services. Patients around the country are getting stuck with enormous medical bills as hospitals continue to mark up the cost of their services, including those for routine medical procedures and advanced surgeries. In the end, the patient is forced to make up the difference.

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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.