‘If you can get it right up front, you’re ensuring accuracy, preventing rework, and preventing denials,’ says Alicia Auman, director of patient access at KSB Hospital. Patient access plays a tremendously important role within the revenue cycle, which is why Alicia Auman, director of patient access at KSB Hospital in Dixon, Illinois, has worked […]
The American Hospital Association (AHA) has asked CMS to include Medicare Advantage organizations in its proposed rule that would streamline the prior authorization process and reduce patient care delays. In December 2020, CMS released a notice of proposed rulemaking about improving prior authorization, following past administrative and clinician struggles. If the rule is finalized, there […]
“Medicare Advantage plans have a unique and growing opportunity to address the needs of socioeconomically vulnerable populations and improve their health,” reports America’s Health Insurance Plans. More plans for individuals with low incomes, as well as targeted SDOH investments and initiatives, round out carrier approaches. On the benefits side, offerings such as meals, transportation, […]
The data, released Thursday by the Centers for Medicare & Medicaid Services (CMS), come as ACO advocates want the agency to give organizations more options to take on financial risk. CMS has shuttered the program in favor of the Direct Contracting model. “Many Next Gen ACOs aren’t moving into Direct Contracting and have expressed a […]
More plans will offer meals, nutrition, transportation or in-home support services at a $0 premium in 2022. Ahead of the annual election period, which began on October 15, the Centers for Medicare and Medicaid Services published information on MA and Part D plan (PDP) premiums, benefit offerings and star ratings. Avalere analyzed that data […]
The delivery and payment of care will look a lot different by 2030, according to CMS. The federal agency has announced that it expects all Medicare beneficiaries with Parts A and B to be in a care relationship with accountability for quality and total cost of care by the end of the decade. At the […]
Since not shopping around can have an impact on enrollees’ coverage and costs, CMS recommends they review and compare plans each year. The numbers are similar across both Medicare Advantage and traditional Medicare, with 68% of MA beneficiaries saying they don’t compare medical plans, and 73% of those in traditional Medicare claiming the same. The […]
The ideal value chain for any industry or company is one built for lifelong customer retention and loyalty. One component of such a chain is a portfolio strategy that continues to offer maximum choice and affordability. For insurers in the Medicare market, this equates to a mix of plan designs and standalone prescription drug […]
How Insurers Are Reshaping Primary Care with Telehealth During the height of the COVID-19 pandemic, telemedicine skyrocketed in popularity as a safe, convenient way for patients to connect with healthcare providers. Today, insurers are banking on its staying power by introducing virtual-first health plans—some of which require patients to start their primary care journey online […]
Organizations that do strong vendor relationships, invest in the organization, and are willing to take on commercial risk will be poised to take on downside risk financial contracts. Through working with population health management vendors, KLAS released a recent report identifying which of their customers are most advanced in adopting downside risk contracts. In the […]