Rejected Payments Top List of Hospital Revenue Cycle Challenges
Payer denials is the top revenue cycle challenge facing hospitals today, according to a study conducted by Besler and HIMSS Media.
CMS Reveals New Direction for MSSP Which Adds Risk on ACOs
CMS announced a “new direction” for the Medicare Shared Savings Program (MSSP) dubbed “Pathways to Success.”
ACA Plan Enrollment Declines to 8.5 Million People
Signups through the ACA health insurance exchanges declined year over year during the 2019 open-enrollment period, CMS revealed on Dec. 19.
Full-Year Results for Shared Savings Program
Change Healthcare and ACO Partner announced results for the first complete plan year of its novel shared savings program with Blue Cross Blue Shield of Arizona (BCBSAZ)
NCQA UM Accreditation Earned By BHM Healthcare Solutions, Inc.
BHM Healthcare Solutions, Inc., (BHM), a leading supplier of behavioral health and medical review services, announced it received accreditation by the National Committee for Quality Assurance (NCQA) in Utilization Management (UM). NCQA UM (Utilization Management) Accreditation reduces duplicative oversight and inefficient gathering of information by organizations.
Health Insurance Plan Ratings for 2018: NCQA Releases Top 10 List
NCQA’s Health Insurance Plan Ratings 2018-2019 compare the quality and services of more than 1,000 health plans in the United States and provide consumers with a practical and meaningful guide to understanding their health care options and choosing the best health plans for themselves and their families. National Committee for Quality Assurance (NCQA) is releasing its 2017 Health Insurance Plan Ratings. These ratings provide consumers with a more accurate picture of how health insurance plans perform in the key quality areas of consumer satisfaction, prevention and treatment.
CMS Pushes ACOs to Take on Risk with Overhaul of MSSP
CMS issued a proposed rule Aug. 9 that would make sweeping changes to the Medicare Shared Savings Program, including overhauling the way ACOs share in risks and rewards.
How Insurers Inadequately Report Medicaid Fraud
The Senate released its version (a.k.a. Better Care Reconciliation Act BCRA) of the House's AHCA. Payers and providers adjust as needed because healthcare reforms, like BCRA, AHCA, and ACA, continuously move through state and federal legislatures. Today's blog, pulls together summaries from numerous resources allowing you a quick glimpse or a deep dive into what waits around the corner. Here are 10 instances which can help you better identify when its time to look for a partner.
AMA Passes Augmented Intelligence Policy
The American Medical Association passed its first policy addressing augmented intelligence in the healthcare industry during its annual meeting in Chicago, which ran June 7 to June 13. The policy suggests tasks for the AMA to address regarding the use of AI in healthcare, with a focus on encouraging healthcare stakeholders and federal policymakers to prioritize "user-centered design." The initiative builds on a proposed a "baseline policy" the association laid out in a May report to its board of trustees.
How Can Medicaid Coverage Combat Opioids?
CMS has released new resources describing how states can leverage Medicaid services and health IT tools to support beneficiaries battling opioid addiction. The organization released an Informational Bulletin to guide states on how to cover critical treatment services for Medicaid eligible infants with Neonatal Abstinence Syndrome (NAS), a postnatal drug withdrawal syndrome occurring primarily among babies exposed to opioids during gestation or shortly after birth.