Machinify, Inc.’s Post

AccendoWave - A Pain #Data Company The Centers for Medicare & Medicaid Services (CMS) is proposing new oversight of accrediting organizations' performance and other changes in response to “several concerns” the agency said have cropped up in recent years. Accrediting organizations, which regularly survey healthcare providers and suppliers to ensure they meet CMS’ health and safety standards, have lately demonstrated “inconsistent” survey results when their standards or practices sometimes differ from CMS policies, CMS wrote in a Thursday fact sheet accompanying its new proposed rule. A Top 4 Global Health Equity Solution and Top 15 Global Remote Monitoring Company, AccendoWave, benchmarks objective brain wave pain data (specialty, gender, age) and has nine #pain databases: Emergency Department, Maternal Health, Oncology, MSK, Medical Surgical, ICU, Women, Adults, Seniors to eliminate bias, improve outcomes and reduce health care costs. If desired, AccendoWave can also create customized pain databases for partners that can be accessed on the Datavant platform.

19 states post #CMS required standardized #quality & #financial reporting comparing performance of #MedicaidManagedCare contractors. The rest are due this October. The reports require “MCO-specific data on grievances and appeals by type of service, as well as external medical reviews, and state fair hearings; evaluation of individual MCO performance on quality measures for #primarycare access and #preventivecare, maternal and #perinatalhealth, #behavioralhealth, and other types of services; medical loss ratios (MLRs) for each MCO; and the sanctions or corrective action plans if any, imposed on each MCO and the reasons for each intervention.” The hope is to compare & contrast #MCO performance both within states & across state lines. #HealthcareQuality #Healthcarecots #HealthEquity #publicprivatepartnership #publicprivatepartnerships #HealthcareReform #HealthcareTransformation

CMS June 28 Round-Up: Key Updates for Healthcare Providers CMS recently released important updates on June 28, 2024, that healthcare providers need to be aware of: 1. Quality Reporting Enhancements: Updates to the Quality Reporting Programs aim to improve patient outcomes. 2. Medicare Payment Adjustments: Changes to Medicare payment policies are crucial for financial planning. 3. Telehealth Expansion: New policies continue to support the growth of telehealth services. 4. Regulatory Compliance: Staying compliant with updated CMS regulations is essential to avoid penalties. For more details, check out the full CMS Round-Up article below: #HealthcareUpdates #Medicare #CMS #Telehealth #Compliance

The complex process of prior authorizations between providers and payers is a growing concern, impacting both patients and healthcare providers. Two key strategies could help streamline and improve this system. Firstly, the Interoperability and Prior Authorization Final Rule, finalized by Centers for Medicare & Medicaid Services in January, aims to enhance transparency and automate information exchange between providers and payers. This rule, though not yet fully effective, is designed to simplify the process and increase accountability, with health plans required to clarify denial reasons and report metrics publicly. Secondly, the adoption of the HL7 Fast Healthcare Interoperability Resources (FHIR) standard is crucial for effective data exchange. Despite its potential, many healthcare systems are reluctant to adopt FHIR due to resource constraints and integration challenges. However, recent updates to the Trusted Exchange Framework and Common Agreement (TEFCA) are expected to support FHIR use more robustly, fostering better data sharing and improving prior authorization processes. Our authorization team streamlines the prior authorization process by leveraging up-to-date rules and standards, including CMS guidelines and FHIR. We ensure swift, transparent communication with payers and maintain adherence to current protocols, ultimately reducing delays and improving efficiency in obtaining necessary authorizations for your patients. We are the One! #revenuecycle #revenuecyclemanagement #priorauthorization #medicalbilling #medicalcoding #healthcare #healthcaretechnology #accountsreceivables #denialmanagement #consulting #management #implementationpartner HealthLeaders

Learn how to reduce the costs related to Medicare Advantage payers. Panelists from Inova and Northwestern Medicine discuss the administrative burdens, low contract yield due to final claims denials, and insufficient data access which are often the largest pain points impacting healthcare providers.

The Federation of American Hospitals (FAH) proposes adding a quality measure to Medicare Advantage (MA) star ratings, requiring health plans to report prior authorization denial rates.   FAH's Level 1 Upheld Denial Rate aims to enhance transparency, discouraging prior authorization abuse by holding health plans accountable. The measure, approved 13-1, focuses on the percentage of initial MA plan denials upheld, overturned, or partially overturned. FAH emphasizes the need for Medicare Advantage plan members to understand the impact of denials or delays due to prior authorization. The proposed measure aligns with efforts to streamline authorization processes, reduce patient stress, and complement existing MA star rating criteria, reflecting a commitment to patient-centric care.   We understand the importance of transparency and accountability in healthcare, and our professionals are dedicated to helping organizations implement effective quality measures that enhance patient care, streamline processes, and contribute to overall healthcare excellence.   Our team of professionals is well-equipped to assist in establishing and refining quality measures, ensuring they align with industry standards and best practices. Whether it involves crafting meaningful metrics, analyzing data, or recommending improvements, our team is committed to setting high standards for quality measures.   We are the One! https://lnkd.in/gTgRcZC4   #revenuecycle #revenuecyclemanagement #priorauthorization #medicalbilling #medicalcoding #healthcare #healthcaretechnology #accountsreceivables #denialmanagement #consulting #management #implementationpartner

There is so much going on in Medicare Advantage right now but what we're really talking about with v28, transparency RFIs, supplemental benefits and MedPAC's $83 billion gap between FFS and MA spending is the question, "how should MA plans and risk bearing providers accurately be paid and how can the system be modernized?" In this Health Affairs piece, Pearl Health's Gabe Drapos and Rubicon Founders' Abe Sutton take a stab at what a modern risk adjustment system could look like. They propose a new system called "inferred risk," which relies in part on data science modeling and, the author's claim, would be both more precise than the overall coding intensity adjustments currently applied while also evening the playing field between large and small players. It's not only worth a read but is also a good jumping off point to look at this system with a new, modern lens. Bonus line in the paper where I learned this piece of CMS rules, "Even in cases like limb amputations, providers must confirm each year via submitted paperwork that a patient’s limb is still amputated. Otherwise, the RAF system operates as if the limb had grown back." https://lnkd.in/eVBt66iE #medicare #medicareadvantage #riskadjustment

For the July issue of Compliance Today, I wrote about guidance issued earlier this year discussing CMS's expectations for Medicare Advantage plan compliance with the new regulations established under CMS Final Rule 4201-F. Many thanks to Health Care Compliance Association (HCCA) for the opportunity to discuss this important and timely topic. #HealthLaw #MedicareAdvantage #HCCA

The American Medical Association (AMA) and a bipartisan group of Congressional leaders are pushing for reforms to eliminate unfair prior authorization practices by health insurers. The proposed legislation, introduced by Rep. Suzan DelBene, aims to modernize the prior authorization process in Medicare Advantage plans by standardizing procedures, improving transparency, and setting deadlines for decisions. Supported by over 370 organizations, the bill seeks to reduce delays in patient care and alleviate the administrative burden on physicians. https://lnkd.in/gwx9z2Q7 #Sandiola #InpatientAcuityCaptureExperts #AcuityCapture #BecauseEveryPatientAndDollarMatters  #RuralHospitals #ClinicalDocumentationIntegrity #ClinicalDocumentation #CDI #BestPractices #Hospitals #DRGoptimization #Healthcare #RROI #ROI #RuralHealthcare #RuralHealth #Technology #Teamwork #HealthcareProfessionals #HealthcareProviders #ACDIS #HealthcareChallenges #HealthCareAccess #Hospital #Medicare #Medicaid #MedicareAdvantage #Telehealth #FinancialPerformance #CDI #SandiolaSuccess #CommunityHealthcare #HealthcareClaims #ProviderChallenges #MedicareAdvantage #ClaimsDenials #HealthcareFinance #RevenueCycleManagement #SandiolaSuccess #Collaborative #HealthcareChallenges #HealthcareFinance #HealthcareDocumentation #DocumentationIntegrity #CDIProgram #CDIServices #CodingIntegrity #CDISpecialist #CDIReview #DocumentationImprovement #RCM #revenuecycle #revenuecyclemanagement