Diagnostic Robotics’ Post

Fierce Healthcare has just published a new article about the Change Healthcare breach. "Change Healthcare issued an update late Wednesday confirming that an analysis of the data accessed in the cyberattack on its systems is underway, and experts say the process of notifying people whose information was exposed could be messy." Read the full article (https://lnkd.in/gpUVSWht) and if you're affected, here are some steps for healthcare orgs to deal with the halted claims processing because of the Change Healthcare hack in March 2024: Short-term Solutions: - Apply for Temporary Funding Assistance from Optum - no fees, interest, cost - expected to start receiving funds within 3-5 days after applying - any provider who receives payments from payers processed by Change qualifies - payment based on average weekly disbursements prior to the hack https://lnkd.in/edX3e8wK - Use another claim clearinghouse. Some report being able to start processing claims through Optum's another clearinghouse, Intelligent EDI (iEDI), within 24 hours https://lnkd.in/e_DVN-Eb. - Contact your MAC to get up to 30 days of accelerated/advanced Medicare Part A/B payments https://lnkd.in/ecv5AaE8 Medium-term Actions: - Diversify your billing services to minimize reliance on a single provider. - Push your EHR/PMS vendor to connect to multiple clearing houses for enhanced resilience and efficiency. - Build a cash cushion or secure a line of credit that you can tap in case of disruptions - Negotiate with payers for better terms in light of current challenges. Long-term Strategy: Accelerate your transition to Value-Based Care (VBC) - VBC's monthly per patient payments offer more stability and less reliance on the volume of claim submissions. Stretch Goal: Lobby your politicians to create a federal healthcare payment clearinghouse similar to FedNow service implemented by the Federal Reserve Board. The challenges we face today, much like the ashes from which the Phoenix rises, lay the groundwork for a stronger, more adaptable future in healthcare. As we navigate these times, let's discuss and share our paths towards rebirth, resilience, and a sustainable healthcare ecosystem. If you know any organization struggling because of the halted claims processing, please share the post with them. If you your organization has deployed other steps to deal with the halted claims processing, please leave in comments.

In today’s healthcare industry, managing costs is a key priority for all healthcare providers. To achieve this goal, the Centers for Medicare and Medicaid Services (CMS) has finalized a prior authorization rule that is expected to save up to $15 billion. This rule has been widely anticipated, and its implementation is a step in the right direction for healthcare providers looking to streamline the billing process. In this article, we will take a closer look at the details of the new prior authorization rule and what it means for healthcare leaders.

A recent survey of members by healthcare improvement organization Premier found that nearly 15 percent of all claims submitted to private payers for reimbursement are initially denied, including many that are pre-approved through a prior authorization process. Going after those denials is expensive. Providers spent nearly $20 billion in 2022 pursuing delays and denials across all payer types. At Covered, we know that there are a proliferation of solutions focused on integrating into the clinical workflow to prevent denials downstream, and we believe in that approach. We also believe that it's not enough. In a world where it costs 20 cents to issue a denial, and over $25 to appeal that denial, and where there is no real punishment for initially denying claims that should be paid, improperly denied claims are not going anywhere. Our mission is to even the playing field for providers. In practice, what that means is automating the hard work of understanding when a denial is incorrect, aggregating the evidence required to prove that, and automating the appeal.   Has your organization seen an increase in denials over the past few years? How have you addressed it?

The healthcare industry faces significant financial challenges, particularly with the recent introduction of the FY24 Medicare Inpatient Prospective Payment System (IPPS) rule. This new rule adds complexity to an already complex system, creating challenges for healthcare organizations. To navigate this new landscape, healthcare organizations must develop effective strategies to ensure financial stability and success. #healthcare #IPPS #healthcarefinanciallandscape

The way healthcare decisions are made is undergoing a major shift. Traditionally, doctors called the shots, but now insurance companies (payers) are taking a more active role. Here's the breakdown: - Medicare Advantage (MA) and managed Medicaid: These growing programs have payers actively managing care, not just paying bills. Think Kaiser Permanente where doctors and payers work together. The Challenge: Payers have a strong incentive to control costs, which can sometimes lead to less care. However, patients can switch plans or return to traditional Medicare. Medicare Advantage plans are also rated based on performance (STARS program). The Future of Healthcare Payments: - To make informed decisions, payers need to combine clinical data (from doctors) with financial data (claims). - The industry is adopting new data standards (HL7 FHIR) that will make it easier to share information. - New CMS rules require payers to make data more accessible through APIs (application programming interfaces). The Payoff: By combining data, payers can potentially make healthcare more efficient and affordable. Learn more: https://hubs.ly/Q02CJmYj0

Medicare reimbursements have been decreasing. This means less money coming into your practice. The consequences? 👉 Less time with patients While it's tempting to rush through appointments to squeeze in more patients to recoup lost revenue, it can affect patient care negatively. 👉 Doctors dropping-out Frustrated by tight budgets, some doctors might consider early retirement or leaving their practice altogether. 👉 Fewer Medicare patients Some practices limit the number of Medicare patients they see to stay afloat. Making it harder for these patients to access care. 👉 Staff cuts Shrinking budgets often leads to staff reductions creating longer wait times and a less pleasant experience for everyone. Our solution: Integrating Medical Virtual Staffing into your practice to help streamline operations and save overhead costs. Here's how: ✅ By delegating time-consuming tasks like scheduling, insurance verification, and data entry to a virtual assistant, you can generate more revenue. ✅ Denial management and medical billing VAs can help your claims be submitted accurately and on time, which will reduce denials and maximize reimbursements. ✅ With VAs handling the admin burden, you can spend more time with patients, leading to better outcomes and happier patients (who are more likely to return for future visits). Virtual staffing is a cost-effective solution that can help you weather the Medicare reimbursement storm. They can streamline your practice, improve your bottom line, and allow you to focus on creating a top-tier patient experience. Book a FREE 15-minute consultation with us to learn more about how our virtual staff can save your practice time and money: https://lnkd.in/gpXbG8be #Healthcare #MedicalPractice #VirtualAssistant #PhoenixVirtualSolutions #MedicareReimbursement

Important update regarding financial assistance for providers affected by the recent cyberattack on Medicare payments. Effective July 12, 2024, CMS will phase out financial assistance for providers whose Medicare payments were disrupted by the cyberattack. As of this date, CMS will no longer accept requests for advanced payments. To date, CMS has disbursed $2.55 billion in advanced payments to Medicare Part A providers and $717.2 million to Part B providers, with 96% of these advanced payments already repaid. In addition, UnitedHealth Group, the owner of Change Healthcare, has contributed $6 billion in assistance to support affected providers. For prompt resolution of any billing or payment challenges, please contact Change Healthcare Source: https://lnkd.in/g9TSf7xj #Medicare #MedicalBilling #Payments #UnitedHealth #ChangeHealthcare #Updates

Healthcare faces unprecedented financial challenges, with the FY24 Medicare Inpatient Prospective Payment System (IPPS) rule adding complexity. Learn how these new requirements impact healthcare organizations and discover strategies for navigating the new landscape. #healthcare #IPPS #healthcarefinanciallandscape

Here are my thoughts on the attached article: As I’ve said many times, a clearly defined Value-Based Payment Strategy and Structure is critical to success in two-sided value-based care models. I recommend eleven key “building blocks” in developing your VB Payment Strategy. It’s no wonder that may hospitals and physician groups experience financial and operational difficulties with their value-based payment programs, as only 50% of the respondents said they have the right protocols in place to assess new opportunities with confidence. For those respondents who do have protocols in place, I agree with them that a system-wide approach to care management and addressing gaps in the continuum of care are two of the most important building blocks that must be built for success with value-based payments. I like the plan of Carilion Clinic to co-brand with a national Medicare Advantage payor.  My recommendation for any health system who is on the continuum of value-based payments is to keep the risk-reward equation in mind. Begin with a Clinically Integrated Network model partnering with Large Self Insured Employer Health Plans. Then move to Medicare Advantage Plans, as these arrangements typically have less 2-sided risk. And once these value-based programs have achieved some level of success, then consider the Accountable Care Organization model with Medicare and Medicaid. The article mentions that CFO’s should ask questions around 1) having the right physicians, and 2) financial viability thresholds, and 3) properly trained staff. These are included in my eleven (11) recommended “building blocks” for achieving success with value-based payments.   And I agree with the article that there will continue to be an ongoing shift to value-based payments, and Medicare has stated they have a goal to tie 100% of Medicare payments to value by 2030. Don’t get caught trying to play catch-up. If you have any questions about your value-based payment opportunities, then reach out and let’s talk.