Category: Blog

Navigating the Financial Impact of Value-Based Care (VBC)

Navigating the Financial Impact of Value-Based Care (VBC)

The financial impact of VBC is profound, necessitating adjustments in how providers approach and manage their financial operations to align with this new model of care. The healthcare industry is shifting towards value-based care (VBC), a model that prioritizes high-quality care while aiming to lower costs. In contrast to the traditional fee-for-service model, value-based care […]
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Medicare Prescription Drug Benefit Premiums Spike Amid Inflation Reduction Act Changes

Inflation Reduction Act: A Double-Edged Sword for Medicare Beneficiaries: The Biden administration’s recent announcement of the first Medicare drug price cuts, mandated by the 2022 Inflation Reduction Act, has dominated headlines. However, another significant impact of this law—substantial premium hikes for some Medicare beneficiaries—has largely been overlooked. The Inflation Reduction Act represents the most sweeping […]
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Overcoming CDI and Coding Challenges: The Power of AI-Driven Solutions

Overcoming CDI and Coding Challenges: The Power of AI-Driven Solutions

Defining the Challenge: Overcoming Obstacles in CDI and Coding: To clarify the overwhelming claims made by technology vendors, I’ve provided some basic definitions. As we embark on this journey, it’s crucial to pinpoint the specific obstacles we face. This will help us demonstrate to senior leadership and stakeholders the need for AI-driven solutions to enhance […]
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Medicare Advantage Prior Authorization Denials on the Rise

Surge in MA Prior Authorization Denials: New Study Reveals A new study highlights significant variation among Medicare Advantage plans regarding the number of determinations made and the frequency of denials. Notably, MA Prior Authorization Denials surged between 2021 and 2022, according to a recent analysis from health policy research. Researchers examined data from the Centers […]
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Value-Based Care: Navigating Challenges and Opportunities in Revenue Cycle Management

Value-Based Care: Navigating Challenges and Opportunities in Revenue Cycle Management

RCM and Value-Based Care Challenges and Opportunities: Healthcare is a dynamic field constantly evolving to improve patient and staff experiences. As the industry transforms, it’s crucial to understand both the potential benefits and drawbacks of these changes. One area experiencing significant evolution is Revenue Cycle Management (RCM). The shift towards value-based care models is a […]
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Latest ICD-10-PCS Codes and Guidelines

Latest ICD-10-PCS Codes and Guidelines

The latest ICD-10-PCS codes and guidelines for the fiscal year 2024 have been unveiled by the Centers for Medicare & Medicaid Services (CMS). With a net growth of 73 codes, the total count of inpatient procedure codes has reached 78,603. Notably, the New Technology Section has experienced the largest surge, introducing 40 new codes. The […]
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Reimbursement-methodology

Understanding Medical Codes and Reimbursement Methodologies

The Role of Medical Codes in Reimbursement Methodologies: Medical codes, such as CPT, HCPCS, and ICD-10 (CM and PCS), are essential components of various reimbursement methodologies. The Inpatient Prospective Payment System (IPPS), used by Medicare fee-for-service, categorizes patient stays into Medicare Severity Diagnosis Related Groups (MS-DRGs) based on ICD-10 codes processed through a computerized system. […]
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Survey Reveals Key Issues with Challenging Surprise Medical Bills and Coverage Denials

Survey Reveals Key Issues with Challenging Surprise Medical Bills and Coverage Denials

A new study by the health care system reveals a significant gap in consumer healthcare rights. Despite attempts to curb surprise medical bills, a large portion of insured Americans are still receiving unexpected charges. Adding to this problem is the high rate of coverage denials, leaving patients with substantial out-of-pocket costs and causing financial hardship […]
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Medicare Physician Fee Schedule 2025: Urology Practice Impact

urology practices: The Centers for Medicare & Medicaid Services (CMS) unveiled its proposed Medicare Physician Fee Schedule for 2025 on July 10, 2024. This outlines potential payment adjustments and policy changes that would take effect starting January 1, 2025. A public comment period will follow, during which CMS will gather feedback to inform the final […]
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GenAI Revolutionizing Healthcare: Transforming Revenue Cycle Management

GenAI Revolutionizing Healthcare: Transforming Revenue Cycle Management

Generative AI is revolutionizing healthcare: Recent breakthroughs have seen these models excel in medical exams, complex diagnoses, and even pandemic response strategies. Advanced language models like GPT-4, Google’s Bard, and specialized healthcare models are now capable of handling intricate tasks that can dramatically improve clinical decision-making and administrative efficiency. The immense potential of Generative AI […]
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