IMAT Solutions’ Post

Our Technology and Analytics team developed Denials Navigator to help you prevent denials proactively! Denials Navigator centralizes and standardizes tracking for all denials prevention efforts and results across your health system. Features include: 🔸Adding structure and transparency to your denial prevention program. 🔸Monitoring progress with clear ROI reporting available in-application. 🔸Decreased time spent analyzing data and increased time spent on denials prevention initiatives. 🔸Real denial rate reduction and associated write-off risk. Learn more at healthrise.com #healthcare #revenuecycle #denials

Terrific article regarding Denials in Hospitals:

Navigating the world of value-based care presents unique challenges from both the payer and provider lenses. "I think the macro difficulty is finding alignment. What are we using to define quality? How are we measuring it? And then, ultimately, what are we looking for in the longer term? And how are we marshaling all of that data," Kang said. "From both sides, the typical challenge is to agree upon all those metrics for a specific patient population. So every time you're having a conversation, either from the plan side with a provider or from the provider side with the plans, each of those conversations is unique; each one is siloed." Dr. Navdeep Kang #ValueBasedCare #PayerProviderPerspective #HealthcareChallenges

What was the most talked about topic among payers in 2023? You guessed it, Medicare Advantage. Over the course of the year, the program underwent significant changes, dominating news headlines and affecting payers both large and small. Take a look at the 10 biggest payer stories of the year from Fierce Healthcare here: https://bit.ly/48Ce0Xz #payer #healthpayer #healthplan #medicareadvantage #healthcaretech #datascience #AI

"Last week, the Centers for Medicare and Medicaid Services finalized a 0.16% cut to the benchmark Medicare Advantage rate, which excludes risk adjustment payments, in 2025. It was the second consecutive year the agency reduced payments and the first time since 2018 that it didn't offer a higher rate in the final rule than it proposed." Engaging and activating members into benefits and care programs that drive higher risk adjustment payments has never been more important. If you aren't leveraging AI driven targeting/personalization + proven journeys, content, and dynamic CTA's we should talk. This exactly what Linkwell Health does for #medicareadvantage clients.

Healthcare organizations continue to experience diminished profits because of denials, emphasizing the need for streamlined #RCM workflows. https://hubs.li/Q02gbFZp0 #healthcareclaims #deniedclaims #RCMinnovation

EHR data vs. traditional claims - robust datasets from real-time EHR data provides the needed depth and breadth of information to develop treatments, medications, and population health plans. #ehr #rwd #healthcaredata #dataanalysis #lifesciences

From health care costs to social isolation to neighborhood safety, the U-M National Poll on Healthy Aging asked those age 50 and over about their level of concern about 26 different health-related issues for older adults in their communities. The top three issues about which respondents across the U.S. said they were very concerned about for older adults in their communities included medical care expenses (56%), the cost of home, assisted living, or nursing home care (56%), and prescription medication costs (54%). Next on the list were financial scams and fraud (53%), health insurance and Medicare costs (52%), and dental care expenses (45%). Read the Report at: https://lnkd.in/g5ZBudqr

Carelon Behavioral Health is supporting many partners from the Association for Community Affiliated Plans (ACAP) as they navigate the significant challenges associated with Medicaid redeterminations, workforce shortages, and rising costs. through industry-leading behavioral health solutions and sustainable value-based financial models.  See how we are solving the rising cost of healthcare together. #medicare #medicaid

Concerned about a lack of transparency and potential issues with prior authorization denials and overpayments, a group of bipartisan senators is urging CMS to collect and publish more data about #Medicare Advantage plans (MA). Here's what they're asking for: - Prior authorization data: Breakdown of requests, denials, and appeals by type of service, timeliness of decisions, and reasons for denials. This would help ensure fair access to care for all beneficiaries. - Justification for denials: Greater transparency around why prior authorization requests are denied would help identify potential biases or inappropriate practices. - Complete encounter data: Accurate and comprehensive data is crucial for tracking plan performance and identifying areas for improvement. - Supplemental benefit utilization data: Better understanding of how beneficiaries utilize these popular benefits would allow for better assessment of their value. - Out-of-pocket costs and provider payments: This information is essential for beneficiaries to make informed decisions about their healthcare plans. - Disaggregated disenrollment data: Identifying groups with higher disenrollment rates could help address issues leading to dissatisfaction with MA plans. - Updated plan comparison information: Easy access to accurate comparisons between MA and traditional Medicare would empower seniors to choose the best option for their needs. Learn more: https://hubs.ly/Q02cHt4b0