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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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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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Hospital Fined $127K for “Persistent” Understaffing of NICU

Scrubs

Dozens of nursing unions have used this tactic to get hospitals to make concessions. But what happens when the hospital fails to hold up its end of the bargain after the strike is over? Failure to comply with the new staffing requirements led the nurses to seek arbitration to hold the hospital accountable. “We

Hospital 189
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Maine Hospital Using AI to Record Patient Conversations

Scrubs

MaineHealth recently announced it is using AI to automatically record conversations between doctors and their patients during a check-up or follow-up visit. Deborah Vaughan, a patient at the hospital, said she appreciates being able to look her doctor in the eye while talking about her health.

Hospital 264
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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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Should Doctors Use Chat-GPT to Practice Medicine?

Scrubs

Dereck Paul is the co-founder of Glass Health, a start-up in San Francisco that offers artificial intelligence chatbot services to doctors looking to ease the burden of routine processes, such as patient documentation. “We need these folks not in burnt-out states, trying to complete documentation,” Paul told NPR.

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Hospital Coding Accuracy: Best Practices for Error-Free Claims

Coronis Health

Hospital coding accuracy is a significant component of the claims process. It’s necessary for hospitals to ensure that they receive the correct reimbursement for their services. Best practices in hospital billing and coding processes are key to guiding coders as they navigate the complexities of chart documentation.