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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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Friday Reflection 41: Sometimes I Just Need to Complain

Sensible Medicine

A 76-year-old woman presents to a community hospital after waking with garbled speech and right-sided weakness. Case 1: Excess An elderly woman is admitted to a community hospital with a minor stroke. The hospital does an excellent job. By the time she leaves the hospital, she has no residual symptoms. I love my job.

Follow-Up 275
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Will New Medicaid Policies Put Hospital Margins at Risk?

EvidenceCare

Written by Carol Howard, VP of Clinical Strategy After a tough few years marked by the pandemic, staffing shortages, and rising costs, hospitals are finally starting to catch their breath. New data reveals a rebound in hospital margins, offering hope for health systems. and operating margins to 5.2%.

Hospital 130
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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.

Billing 245
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Nurse Researcher Wants to Change How Providers Think About Health Literacy

Scrubs

If patients are having trouble following the latest health recommendations, providers can engage with the community to better understand why these problems persist. Yet, every time they would come into the hospital, we would discharge them with the same plan. has a health literacy problem of its own.

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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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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.