Tag: Health Plans

Prior Authorization in Medicare Advantage : Lawmakers Call for Streamlined Process

CMS has proposed a rule to simplify prior authorization in government-sponsored health insurance programs. However, some lawmakers are urging the agency to do more. A bipartisan coalition of 233 representatives and 61 senators have written a letter to CMS requesting that the proposed rules be expanded and that the changes be finalized quickly to enhance […]
Learn More
How AI is Solving Big Challenges During COVID-19

How AI is Solving Big Challenges During COVID-19

Artificial intelligence is changing the way we think about healthcare during the COVID-19 pandemic, opening our eyes to new opportunities to use machine learning to draw useful conclusions faster. Before COVID-19, one of the biggest challenges healthcare organizations faced was how to accelerate and scale their application of AI—clinically and operationally. Now, the use cases […]
Learn More
CMS Finalizes Additional Payment for New COVID-19 Treatments

CMS Finalizes Additional Payment for New COVID-19 Treatments

CMS’ Fourth COVID-19 Interim Final Rule with Comment Period (IFC-4) includes additional payment for new COVID-19 treatments, price transparency requirements for COVID-19 diagnostic tests, and coverage for potential vaccines among other provisions. Most provisions of IFC-4 became effective November 2. Hospital Payment for New COVID-19 Treatments The New COVID-19 Treatments Add-on Payment (NCTAP) will provide additional Medicare […]
Learn More
AI Can Help Health Plans Become Member-Centric

How AI Can Help Health Plans Become Member-Centric

Improving the customer experience is no longer an idea that’s relegated to the retail or hospitality industries. Now, the idea has gained traction across many industries, including healthcare. For health plans, improving the customer experience and providing member-centric care helps drive member acquisition and retention and improve reimbursement (via a better STARS rating). With so […]
Learn More
Surprise Medical Bills

Insurers, Providers Spar Over Solution to Surprise Medical Bills

America’s Health Insurance Plans called on Congress to set a fixed reimbursement rate based on what insurers pay in a region. Providers are pushing back against an insurer proposal for legislation to set reimbursement rates to avoid surprise medical bills. In a letter to Senate and House leaders this week, America’s Health Insurance Plans and 16 other […]
Learn More
Patient Satisfaction

How to Drive Patient Satisfaction and Financial Results with a Modern Medical Billing Process

Most industries embrace the motto “the customer is king.” They are acutely aware their success is driven by it. While the complexity of the healthcare business model has made it challenging for provider organizations to adopt such an ethos, the recent rise of consumerism in the industry necessitates that providers prioritize the patient experience if […]
Learn More
Preparing Providers For Value-Based Care

Preparing Providers For Value-Based Care, Consumerism In Healthcare

Technology can transform data into actionable insights for providers needing to meet the demands of value-based care and consumerism in healthcare. Transforming raw data into actionable information is crucial to the financial future of provider organizations, especially as pressure builds on providers to align their care delivery approach with value-based care and consumerism in healthcare. […]
Learn More
x