As Medicare Advantage denial rates climb, health systems are dropping plans and steering patients back to traditional Medicare. Pearl Health CEO Michael Kopko thinks the original Medicare Advantage bargain has broken down — and that the model may never have been as efficient as policymakers assumed.
At the end of the day, the most important question is a simple one: Do you actually know if you’re being reimbursed correctly?
Healthcare decision-makers, especially at pharmaceutical companies, must prioritize patient input. Data collected from social media listening is a significant step in the right direction.
CMS' proposed 2027 Physician Fee Schedule would bar Medicare payment for remote monitoring services delivered by third-party vendors, following OIG reports that flagged widespread fraud in the space.
Counting hospital closures only tells part of the story, noted Duane Fitch, partner at Plante Moran. Across the country, hundreds of hospitals remain technically open while steadily shedding services their communities depend on, such as emergency care, obstetrics and psychiatric care.
Building a medical practice that’s truly resilient can feel like pushing a rock up a hill. However, physicians who are ready, willing and able to stay adaptable and seize opportunities will give their medical practices staying power.
Innovators who holistically develop their products, studies, and payment strategy with these things in mind will reduce risks, spend less, and reach profitability sooner.
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Deploying AI-driven segmentation at an enterprise level goes beyond operational efficiency. It signals a commitment to pioneering the next era of precision healthcare.
Physicians are facing rising workloads, shrinking support staff and declining reimbursement — resulting in a burnout crisis and threatening the sustainability of independent practices. Experts say urgent Medicare payment reforms are needed to prevent further consolidation, as well as preserve access to care.
Two U.S. representatives have introduced the Prompt and Fair Pay Act, a bipartisan bill that would require Medicare Advantage plans to reimburse providers at least the same rates as traditional Medicare, as well as pay claims more promptly. Providers and industry groups have welcomed the proposal, citing mounting financial strain and growing concerns over care delays and denials.
Hospitals’ flat revenues are clashing with rising costs and excessive reimbursement denials from payers, said Rod Hanners, CEO of Keck Medicine of USC. He warned that policy efforts focused solely on limiting provider payments ignore the larger issue of unchecked profits among payers, drugmakers and other healthcare industry players.
What if health plans could identify member decline before an avoidable hospitalization occurs? Real-time clinical visibility into long-stay SNF members uncovers risk earlier and drives better outcomes.
A bipartisan group of lawmakers introduced legislation this week to extend CMS’ hospital-at-home waiver for five more years, allowing hospitals to continue delivering acute care in patients’ homes with Medicare reimbursement. The move comes as research shows this model reduces mortality and healthcare costs.
This week, CMS established a reimbursement code for Eko Health’s AI platform, which seeks to aid clinicians in the diagnosis of heart conditions. The goal behind the technology is to help catch heart disease earlier, when it’s easier to treat, and to make high quality diagnostic care more accessible.
Pear Suite recently won the payer/provider technology track of MedCity News’ INVEST Pitch Perfect contest. The startup provides a software platform for community health workers that helps them share data, submit claims and maintain compliance.
New research found that most healthcare CFOs anticipate minimal financial gains this year due to high labor costs and insufficient payer rates. While providers are leveraging more data to improve financial planning, persistent challenges like wage pressures, recruiting difficulties and payers' increasing use of technology to deny claims continue to strain margins.
High labor costs remain an ongoing problem threatening providers’ bottom lines, according to new data from Kaufman Hall. The research revealed that medical groups’ median investment in each employed physician has reached more than $300,000 for the first time.