Tag: Healthcare providers

CMS Proposes Changes to Medicare Advantage and Part D Programs

CMS Proposes Changes to Medicare Advantage and Part D Programs

On January 12, the Centers for Medicare & Medicaid Services (CMS) released the Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs proposed rule, representing CMS’ first major policy proposals for these programs in the Biden Administration. The changes proposed are, overall, modest in scope. In the […]
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Electronic Payment Key to Streamlining Healthcare Claims Management

Electronic Payment Key to Streamlining Healthcare Claims Management

The complexity around healthcare claims management is a major pain point for provider organizations, big and small. The increasing cost of claims coupled with a complex system of many payers, each with their own rules and requirements, creates administrative burdens and obstacles for providers. Ultimately, this complex system impacts the patient experience, as patients must […]
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Health Equity and SDOH: A Payer Perspective / Update

Health Equity and SDOH: A Payer Perspective / Update

As part of its ongoing mission to improve the health of America, the Blue Cross Blue Shield Association (BCBSA) announced its National Health Equity Strategy in April 2021 to confront the nation’s crisis in racial health disparities. This strategy is intended to change the trajectory of health disparities and reimagine a more equitable health care […]
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How Population Health, Risk Stratification Support Value-Based Care

How Population Health, Risk Stratification Support Value-Based Care

To excel in value-based care, providers must lean on strategies for managing population health and skillful risk stratification. Amid the COVID-19 pandemic, organizations observed the ramifications of fee-for-service, leading to communication and revenue challenges for both providers and patients. While value-based care is not a novel idea, the pandemic greatly accelerated the adoption of this […]
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As Revenue Cycle Management Expands, Automation Is Key

As Revenue Cycle Management Expands, Automation Is Key

  In its simplest form, revenue cycle management is the process healthcare providers use to ask for, track, and collect revenue for services rendered to patients. But as medical billing gets more complex, revenue cycle management is expanding beyond the business office. At Jackson Hospital in Montgomery, Alabama, for example, revenue cycle management also includes […]
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No Surprises Act Notice Requirements: The Good and Bad News for Providers

No Surprises Act Notice Requirements: The Good and Bad News for Providers

Surprise billing occurs when patients receive care from out-of-network providers without their knowledge. On July 1, the Biden Administration passed an interim final rule: the first portion of the “Requirements Related to the Surprise Billing Act,” in an attempt to curb excessive costs patients are required to pay in relation to surprise billing. The rule […]
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Key Ways Providers Can Prepare for New Surprise Billing Rules

Key Ways Providers Can Prepare for New Surprise Billing Rules

Starting January 1, 2022, healthcare providers will be subject to a new surprise billing law that makes it illegal for providers to bill patients more than in-network cost-sharing for out-of-network services and establishes an arbitration process to resolve unexpected out-of-network charges. The law, the No Surprises Act, was passed in December 2020 as part of […]
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The Importance of Data Security in Medical Facilities

  Today, data breaches, ransomware attacks, and identity theft are endangering privacy and well-being. This is true for medical data because if malicious hackers get access to it, human lives and health could be at stake. Scammers may also attempt to benefit from ongoing events to disrupt the data gathering process for healthcare corporations. Medical […]
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Predictive Healthcare Forecasting Key to Provider Survival in 2021

Predictive Healthcare Forecasting Key to Provider Survival in 2021

Healthcare forecasting that can adapt quickly to changes could be as critical to a provider organization’s survival in 2021 as wearing a mask to stop the spread of COVID-19, experts at PwC’s Health Research Institute are saying. Nearly three-quarters of healthcare executives (74 percent) recently surveyed by the Health Research Institute said their organizations would […]
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AMA Creates CPT Codes for AstraZeneca’s COVID-19 Vaccine

AMA Creates CPT Codes for AstraZeneca’s COVID-19 Vaccine

In anticipation of an emergency use authorization from the Food and Drug Administration (FDA), the American Medical Association (AMA) has created Current Procedural Terminology (CPT) codes for AstraZeneca’s COVID-19 vaccine. AMA assigned Category 1 CPT code 91302 to the vaccine manufactured by the Cambridge, United Kingdom (UK) company, as well as vaccine administration CPT codes […]
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