The Age of Action: Seizing CMS’s Call to Reimagine Medicare
The combination of coverage awareness and care navigation powered by agentic AI has the potential to transform how older adults engage with the healthcare system.
CMS’s Final Rule Impacting Star Ratings Puts Outcomes In Focus — Are Health Plans Ready to Take Action?
This is a great opportunity to align your strategies with CMS’s evolving framework by refining care models to focus on impact, investing in digital capabilities that support data use, and continuing to build infrastructure that addresses disparities in care.
Solving Healthcare’s Provider Data Problem Starts with Interoperability
Break down the silos. Take control of your provider data.
What is Concurrent Review?
While prior authorization has made many headlines over the past year, concurrent review has not. Yet missteps in both processes leave hospitals in danger of not getting paid, which can result in higher costs being passed down to patients.
A Reality Check on SDOH: Challenges We Can’t Ignore
A very small percentage of health outcomes are tied to direct healthcare activities. The non-medical factors, conditions in which people are born, grow, live, and work in, more often than not, impact health outcomes more than the clinical care they receive.
Value-Based Care Gets Real
The mandatory CMS TEAM program begins next year. Are you ready? As hospitals consider their options for addressing the mandate, here are some actions to consider.
How the Healthcare Industry Can Soften Blow from Medicaid Cuts
By adopting a fresh approach that places the right people in the right programs, including AI-enabled enrollment, health plans, the healthcare industry will be in a better position to weather impending federal cuts – and maybe even end up better for it.
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The 5 Best Medical Billing Outsourcing Companies
Medical billing is a tedious administrative task, but outsourcing it may be the key to increased revenue. Explore the top medical billing outsourcing companies and the benefits of partnering with one.
Payer Advocates Applaud 5% MA Payment Increase
CMS recently announced that payments to Medicare Advantage plans will increase by 5.06%, drawing support from payer advocates.
What Issues Do Healthcare Leaders Want Dr. Oz to Tackle as CMS Administrator?
Healthcare leaders hope Dr. Oz supports Medicare Advantage, nutrition and telehealth as CMS administrator.
Cautious Pessimism – What Isn’t Being Talked About, And What It Means For Healthcare
The lessons learned and shared by some of the industry’s leaders are exciting, and some clear opportunities are developing. But under the surface, this year, there is something else, and I’m not sure it’s getting enough attention: anxiety.
The Promise and Peril of Price Transparency Under Trump’s New Executive Order
President Donald Trump’s latest executive order aims to strengthen enforcement for CMS’ price transparency requirements. Some experts think greater price transparency could reduce healthcare costs by fostering more competition, while others are concerned about the potential effects on hospital-payer negotiations, as well as the practicality of enforcing these requirements.
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Your Guide to the Best Vein Clinics in Orlando
Your varicose or spider veins may indicate an underlying problem, so finding the right vein specialist is crucial. Discover the best vein clinics in Orlando.
How Expanded Reimbursement for Coronary CTA (CCTA) Could Improve Cardiovascular Outcomes
With better access to tools like CCTA and diagnostic tools that leverage CCTA, clinicians can better support their patients in managing overall cardiovascular health, patients will benefit from less invasive care and enhanced quality of life, and health systems could ultimately see reduced costs and streamlined workflows.
Many Community Pharmacists Won’t Carry Drugs in Medicare Negotiation Program, NCPA Warns
According to the National Community Pharmacists Association, 60.4% of independent pharmacists are weighing not stocking one or more of the first 10 drugs in the Medicare Drug Price Negotiation program. Another 32.8% have already decided not to stock one or more of the drugs.
Late to APP Reporting? Untangle Your ACO’s Optimal Method
Reporting quality on all beneficiaries marks a major shift, requiring thoughtful preparation and strategic planning. If your Accountable Care Organization (ACO) hasn’t started yet, don’t worry — there’s still time to get on track.
Dr. Oz at Medicare: Why America’s 53 Million Family Caregivers May Finally Get Their Due
While many view Dr. Mehmet Oz's nomination to lead the Centers for Medicare and Medicaid Services (CMS) with skepticism, there's a compelling case that his unconventional background could catalyze long-overdue support for family caregivers.
Common MRF Mistakes Hospitals Are Making in 2024
Updated schema requirements are easy to mix up — here are a few simple solutions