Alyssa Steinman

For payers and providers, risk adjustment data validation and Office of Inspector General audits are here to stay. And, with #Audits happening as far back as 2014, do you know where you stand? EXL’s webinar explores how mock audits can help you grasp your risk and take proactive action. We help you assess risk and implement corrective action, policies, and procedures before your credibility and revenue take a hit. Don’t wait until it’s too late — dig into the webinar now. https://bit.ly/45iFAZm

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RevCure understands the importance of accurate and complete clinical documentation.  Our Physician CDI Program Includes: ✓ Clinical Documentation Assessment ✓ Physician Education and Training ✓ Documentation Improvement Strategies ✓ Ongoing Support and Monitoring Our CDI Analytics Services Include: ✓ Performance Reporting ✓ Data Visualization ✓ Trend Analysis ✓ Predictive Analytics #revcure #revenuecyclemanagement #healthcareconsulting

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Rhode Island continues to improve care by spotlighting prior authorization hurdles and recommendations Prior authorization holds some utility for promoting the efficient use of health care resources. It requires providers and practices to get approval from insurers before some medical services can be provided and is meant to assure patients are receiving safe and appropriate care. However, prior authorization has also contributed to delays and inefficient care, frustrating providers and patients. There is an emerging consensus that process improvements and removal of prior authorization from some services are warranted. In a recent report released by the Office of the Health Insurance Commissioner (OHIC) and submitted to the General Assembly, OHIC documents the discussions of the Administrative Simplification Task Force in order to make recommendations regarding the prior authorization process. The report notes that payers have unilaterally taken the initiative to reduce prior authorization. UnitedHealthcare and Point32Health have removed prior authorization from a host of services. Blue Cross & Blue Shield of Rhode Island (BCBSRI), which took bold steps to eliminate prior authorization for behavioral health services in 2018, recently announced plans to materially reduce prior authorization requests managed by primary care providers. BCBSRI used data to identify some of the most common orders that create more work for providers. Reviewing the data will lead to lifting prior authorization requirements for several medical services, including radiology and cardiology. “In recent years Blue Cross has been innovative and thoughtful in its approach to reducing the burden of prior authorization on health care providers. I applaud Blue Cross for this action to materially reduce the burden of prior authorization on primary care providers in the state and I’m hopeful that other insurers will take note of this action and follow suit," said Health Insurance Commissioner Cory King. Point32Health also announced updates to its prior authorization requirements for commercial services in April and expects to remove more in the coming months. These examples are positive steps toward easing the clinical administrative burden caused by prior authorization. Read the OHIC Prior Authorization Report: https://lnkd.in/eXEBAidb

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Next year, payers will need to increase member communication on supplemental benefits, per new rules from Centers for Medicare & Medicaid Services. Find our summary of the changes and ways to reduce related operational challenges: https://lnkd.in/gz6PN7g2

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💡Is good clinical documentation healthcare’s secret weapon? 🚀🗂️ 📺 It might not make for a thrilling medical drama storyline – but top-quality clinical documentation is the linchpin of good healthcare. When comprehensive and accurate, clinical documentation tells the true patient story, serving as a primary source of health data. This ensures a patient’s care team – now and into the future – has all the information they need to deliver the best possible care, for the best health outcomes. 🌟 🪙 Not to mention the benefits accurate documentation brings to the healthcare bottom line. By recording all treatments and services rendered, healthcare organizations can bill accurately, balance their budgets and keep the lights on so they can continue to provide vital services. 💡 However, upholding quality documentation has historically been challenging. Clinical documentation is time-consuming and vulnerable to human error. 🧑‍💻 And gaps in existing and legacy medical records pose a challenge – especially as care teams change hands or organizations shift from paper-based records to hybrid digital systems. 📝 💻 As a result, many healthcare organizations still find themselves struggling with the challenges of low-quality or unspecific clinical documentation, not to mention finding time to review records when there’s patient consultations and treatments to attend to. On the flipside, the costs of poor documentation are high – negatively impacting health outcomes for patients as well as the bottom line. 📉 That’s why the most forward-thinking healthcare organizations are fostering a documentation-centric culture and tidying up their backlog with the help of specialists and innovation. ⚕️🧬 That’s where clinical documentation integrity (CDI) comes in. CDI is a concept that’s been flying under the radar for a while – embraced by innovative healthcare organizations while still relatively unknown in the larger healthcare ecosystems. But its potential for healthcare organizations is transformative. 🚀 Simply put, CDI is the process of reviewing medical records to spot gaps and achieve the best quality data – while ensuring that going forward, clinical documentation is recorded to the highest standard. 📑 ✔️ A robust CDI program or strategy includes elements like a dedicated CDI team, regular audits, ongoing healthcare staff training in documentation best practices, and leveraging technology to improve documentation proactively. 🤖 💻 🧑🏽‍💼 It’s a huge topic - and unchartered territory! 🧭 So over the coming weeks, we’ll be exploring the ins and outs of CDI in bite-sized chunks on our channels - and we’ve written an easy-to-understand blog to get you acquainted with the topic! 🖊️ Read it here ➡️➡️➡️ https://lnkd.in/ewPQpM7W Have you heard of CDI? Let us know in the comments! 💬

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New CMS report: The Medicare Shared Savings Program (MSSP) continues to demonstrate its effectiveness in delivering high-quality care while generating significant cost savings. Key highlights from the report: - MSSP generated $1.8B in savings for Medicare in 2022 - 483 ACOs participated, serving 11 million Medicare beneficiaries - 99% of ACOs successfully reported quality measures - 54% of ACOs earned shared savings payments These outcomes reinforce that VBC can drive care quality while improving financial outcomes for the ACOs who participate. Check it out here: https://lnkd.in/dJDNU6-c #Valuebasedcare #healthcareinnovation #ACOs #Medicare

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With the CMS 2025 Medicare Advantage and Part D Final Rule announcement, what have we learned?  Well, depending on your role in the process (Health Plan, Agent, FMO) you may be facing challenges to prepare for the October 1st implementation date.  Challenges like: What does your contracting look like?  How will you keep your downlines engaged?  And which value-added services does your organization bring to the table?  As we all begin to ask ourselves these questions one thing is for sure, being reactive is far worse than being proactive! Trusty.care has the tools in place now to demonstrate how and why agents and FMOs are a value-add in the Medicare Advantage enrollment process.  Helping to identify the needs of your members, providing members with the plan and benefit information they need to make the right decision, and connecting agents to the tools they need to better support their member’s successful health outcomes is what we do.  When everything is connected, anything is possible! #medicare #CMS #finalrule #medicaresales #connection #healthisurance #FMOs #healthoutcomes

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OP CDI programs establish policies designed to review select diagnoses that the OIG has determined to have been historically overpaid. By creating a policy to review these diagnoses, denials will be minimized, and institutions and providers will be less exposed to potential fines from inaccurate claim submissions. Read more here: https://lnkd.in/gjsJHbtk #OPCDI #ProviderClaims #CDI

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This week, a bipartisan group of U.S. House and Senate leaders has reintroduced a key bill that would streamline prior authorization for Medicare Advantage plans. The Improving Seniors’ Timely Access to Care Act would support the 1.4 million Pennsylvanians covered via Medicare Advantage. U.S. Representative Mike Kelly (R-PA) was among the elected leaders to introduce the bill. HAP President and CEO Nicole Stallings said: “The Improving Seniors' Timely Access to Care Act takes critical action to address the denial of care by Medicare Advantage plans. Prior authorizations delay and prevent patients from receiving the timely care they need and deserve. This bipartisan legislation will improve access to care for Pennsylvania seniors by removing barriers that delay essential medical care and reducing burden on providers.” “HAP and Pennsylvania hospitals support and thank Representative Kelly for his leadership on this issue.” Learn more: https://lnkd.in/eSS2AQUp

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📢 URGENT: Don't miss our Medicare 101: Understanding the Basics webinar TOMORROW, June 26 at 10am PDT, 12pm CDT, 1pm EDT! 📢 This informative session is perfect for those turning 65 and enrolling in #Medicare for the first time, current Medicare beneficiaries who want to understand their options, and caregivers helping with Medicare decisions. Join us to gain crucial insights, get your questions answered by experts and ensure you're making the best choices for your healthcare. Register now and submit any questions you'd like addressed during the webinar: https://lnkd.in/gtnxjhEV

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Retrospective reviews are a valuable part of the risk adjustment workflow; however, spotting and closing risk gaps after the claim has been submitted still leads to avoidable delays in receiving accurate care funding. Adopting prospective risk adjustment workflows enables you to close those gaps before the claim is submitted, not after. And as we explain in this video clip, that’s just one of the many benefits of adopting prospective risk adjustment processes. https://lnkd.in/ePeGTiPB #riskadjustment #carefunding #healthtech

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Have you registered yet? If you want to transform your risk adjustment strategy, don't miss out on this free webinar with speaker and national risk adjustment expert, Jack Newsom, Sc.D. https://lnkd.in/dYa28AZy #RiskAdjustment #CMS #Medicare

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Impact of Policy Changes on SNF Billing Let's know about how recent policy changes affect Skilled Nursing Facility (SNF) billing: 🔹Understand new reimbursement rules. 🔹Adapt to updated documentation requirements. 🔹Navigate changes in Medicare/Medicaid guidelines. 🔹Prepare for potential shifts in billing procedures. Ready to navigate these changes effectively? Let's discuss how they impact SNF billing practices today! Know more: https://bit.ly/452uyGo For more insights, Contact 24/7 Medical Billing Services for a free consultation at  888-502-0537 / [email protected]. #SNFBilling #HealthcarePolicy #MedicalBilling #MedicareBilling #HealthcareRegulations #SNFReimbursement #HealthcareFinance #BillingCompliance #MedicalBilling #LongTermCare #SkilledNursingFacilities #BillingUpdates #ReimbursementRates #SkilledNursingFacilityBilling #247MedicalBillingServices

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Medicare coverage verification is the process of checking that a healthcare service or item will be paid for by Medicare before it is provided. Here are 6 best methods for healthcare providers to verify Medicare Coverage:

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With Open Enrollment underway, supporting members as they navigate their new health plan is top of mind for healthcare payers. Relay is here to help! 🤝 Relay was recognized as a Sample Vendor for Health Management and Navigation in a recent Gartner® Report. Check out the report and reach out to learn more about Relay's work with healthcare payers during open enrollment and beyond! #openenrollment #memberengagement #healthnavigation https://hubs.li/Q02YQ6Hg0

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Skilled nursing facilities (SNFs) and other #Medicare providers must report related parties and related-party costs on their cost reports. An HHS-OIG audit found that in a sample of 14 SNFs, 3 failed to disclose related parties, and 7 overstated costs by $1.7 million. Medicare contractors did not review these issues, and CMS did not provide clear guidance on allowable costs. Read more: https://direc.to/fkfk

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