Sift Healthcare’s Post

I hate #denials. They are increasingly used as a way to retain revenue by payers and not as a mechanism to ensure payment integrity. See my #nosurprisedenialsact, we need payers to simply deny based on a claim's merit, not based in revenue retention. (https://lnkd.in/gXZ5mFPr) Check out this succinct article on the things you can do in your own #revenuecycle today to address the #denialscrisis from my friends at Signature Performance, Inc. and Lily Keogh!

Medicare spends trillions of dollars per year. Those dollars are paid out using two payment models. In this weeks Medicare Market Insights deep dive we compare and contrast: Fee-for-service And Capitated Give it a read here: https://lnkd.in/gRFfKjdh

🚨 IMPORTANT COVERAGE DEADLINE APPROACHING 🚨 The Medicare Annual Enrollment Period will end on DECEMBER 7th! This period of time exists for Medicare beneficiaries to review & make changes to Part D drug coverage as well as review & make changes to their Medicare advantage plans (if applicable). We have seen these annual reviews result in better drug coverage, unexpected savings (some in the $10k+ range this year) and an opportunity to instill confidence into a client about their Medicare coverage. If you're someone who works with Medicare beneficiaries regularly - take a moment to check in with them to make certain their annual review has been completed! At Move Health Partners, we exist to make health coverage simple & clear. We are a fiercely people-centric team that will always act in the best interest of those that we serve. Are you a financial planner, advisor or wealth manager? Are you urging your clients to do an annual Medicare review during AEP? Are you connecting with them prior to their 65th birthday in order to prepare them to make important healthcare decision in the coming months? ^ If the answer to the above is yes, congrats! You're covering an important part of your client's financial plan. Are you working with a trusted partner to complete the analysis and enrollment of suggested plans? ^ If the answer is no, that's okay! Our team at Move Health Partners can help. I'll drop my meeting scheduling link in the comments - let's connect. Health & Wealth collide often - having access to an expert team to help inform important decision can be invaluable. #MedicareAEP #MedicarePlanning #MedicareReview #MoveHealthPartners #FinancialPlanning #HealthandWealth

Really? Denials were issued on 7.4% of all MA Prior Authorization requests in 2022. Prior Authorization Denials were UP 24% between 2019 and 2022. Sorry folks, this is ridiculous. Plans are using denials as a financial management tool that has little to do with managing member health. On appeal, only 2 in 10 denials are upheld. Here is the game... plans know that only 10% of denials are appealed. They make the process difficult, time consuming for providers and keep the rules vague. When the MA program started to gain traction in the early 2000's, denials were less than 2%. Do we really think that providers are 400% worse at practicing medicine than they were in 2000? Plans should be required to publish the exact criteria they are using on each prior authorization and should make an appropriately boarded specialist available in real time for a pre-submission discussion and binding authorization and payment commitment. Do we still believe plans are not practicing medicine? If plans don't stop pushing the envelope, politicians will remove prior auth as a tool.

4 things to know about the 'Medicare' program 1. Medicare is a national program that subsidizes healthcare services for anyone 65 or older, younger people with disabilities, and patients with end-stage renal disease. 2. Medicare is divided into four components: Medicare Part A, Part B, Part C (also called Medicare Advantage), and Part D for prescription drugs. 3. Medicare Part A premiums are free for those who made Medicare contributions through payroll taxes for at least 10 years. 4. Patients are responsible for paying premiums for other parts of the Medicare program. PS: This content is exclusively created and licensed to financial advisors using our platform (we have over 500 posts ready to use that have got over 600,000 impressions and are growing on LinkedIn every single day; this means people like our content a lot more than standard advisor company-posted content). Please reach out to me if you would like to get access to our AI-powered next-generation platform. 👍 #medicare #medicareinsurance #healthinsurance #medicarecoverage

In September 2023, we published a post on how payors using AI to process Medicare Advantage (MA) claims has been driving a rise in denials. This post covers some of the latest trends in Medicare Advantage plans, including hospitals, health systems, and physician practices dropping MA plans, while some payors are selling off their MA plans. https://lnkd.in/gBfy227B

A common question we are asked is why do I pay different medication copay amounts each month. In Bethany's new 'Basics of Medicare' presentation, she provides a graphic to explain the drug payment stages and to address the different medication costs depending on the phase of the model. If you are financial advisory firm, company or P&C carrier looking for a speaker to educate your clients or employees, her presentation provides a comprehensive overview of Medicare basics and topics include; Parts of Medicare (A, B, C and D) Do I qualify Timing and process of enrolling Supplement plan vs Advantage plan Part D medication plans (including payment stages) Election periods Late enrollment penalties Health Savings Accounts

4 things to know about the 'Medicare' program 1. Medicare is a national program that subsidizes healthcare services for anyone 65 or older, younger people with disabilities, and patients with end-stage renal disease. 2. Medicare is divided into four components: Medicare Part A, Part B, Part C (also called Medicare Advantage), and Part D for prescription drugs. 3. Medicare Part A premiums are free for those who made Medicare contributions through payroll taxes for at least 10 years. 4. Patients are responsible for paying premiums for other parts of the Medicare program. PS: This content is exclusively created and licensed to financial advisors using our platform (we have over 500 posts ready to use that have got over 600,000 impressions and are growing on LinkedIn every single day; this means people like our content a lot more than standard advisor company-posted content). Please reach out to me if you would like to get access to our AI-powered next-generation platform. 👍 #medicare #medicareinsurance #healthinsurance #medicarecoverage

4 things to know about the 'Medicare' program 1. Medicare is a national program that subsidizes healthcare services for anyone 65 or older, younger people with disabilities, and patients with end-stage renal disease. 2. Medicare is divided into four components: Medicare Part A, Part B, Part C (also called Medicare Advantage), and Part D for prescription drugs. 3. Medicare Part A premiums are free for those who made Medicare contributions through payroll taxes for at least 10 years. 4. Patients are responsible for paying premiums for other parts of the Medicare program. PS: This content is exclusively created and licensed to financial advisors using our platform (we have over 500 posts ready to use that have got over 600,000 impressions and are growing on LinkedIn every single day; this means people like our content a lot more than standard advisor company-posted content). Please reach out to me if you would like to get access to our AI-powered next-generation platform. 👍 #medicare #medicareinsurance #healthinsurance #medicarecoverage

In the latest issue of Radar on Medicare Advantage: Full-year 2023 earnings show MA insurers aren't out of the woods, how the industry is bracing for Part C rate cuts, the Part D red tape that could be worsening outcomes for low-income seniors, and more top stories. https://hubs.ly/Q02lcztZ0