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Modernizing your systems is no longer optional. It's the key to thriving in today's fast-paced tech landscape. While outdated systems can lead to higher costs and lower performance, this transition can help pave the way for further success for your organization. Here are several reasons why you should make the shift to modernization. Are you ready to evolve your business? Visit pointwest.com to find out how Pointwest can help accelerate your digital transformation journey today! #AccelerateToTheFuture  #TakeITFurther #Pointwest

Unlock your company’s digital potential with Pointwest! We provide our partners with the tools, talent, and expertise to help drive their businesses forward at the speed of digital. Partner with us and discover how we can accelerate your digital transformation journey by visiting: https://lnkd.in/gq5rqNzr #AccelerateToTheFuture  #TakeITFurther #Pointwest`

Humana's MA Clawback Lawsuit to move forward. A federal judge has ruled that Humana's challenge to a CMS rule implementing stricter auditing standards on MA plans can proceed. 👨⚖️ Humana's lawsuit against CMS's new risk-adjustment rules will proceed despite HHS's attempt to dismiss it 💲 The new rules aim to recover $4.7 billion in overpayments to MA plans over the next decade. 🔻 Humana, the second-largest Medicare Advantage insurer, is facing the largest substantial financial risk. Due to potential clawbacks, it will lose up to 17% of its 2023 earnings, a staggering $900 million. This is a significant concern, especially with the MA market expected to grow and 6.1 million MA members currently enrolled in Humana's plans. With the lawsuit moving forward, it's crucial to consider: Will this decision lead to increased scrutiny of MA plans? What could be the potential implications for patients and providers? How will CMS's new audit methodology affect the financial sustainability of MA plans, and what are the potential consequences for the healthcare industry? Considering the recent HHS vs. SCAN win, the government's increasing momentum in its efforts to recover alleged overpayments and its commitment to ensuring the financial sustainability of the MA program is highlighted. #MedicareAdvantage #Humana #HHS #HealthcareLaw #RiskAdjustment #CMS #Clawback #HumanaMA #HealthcareRegulation https://lnkd.in/gy_FgiRK

Great read! Below is a brief guide discussing the adoption, implementation, benefits, challenges, and potential improvements to current healthcare interoperability structures. Interoperability in healthcare is essential for a revolutionary future. The potential impact is immense: from personalized patient care to streamlined operations, the benefits of interoperability are boundless. As healthcare organizations come up with new innovative ways to partner, merge and consolidate, the integration of disparate systems and data becomes a significant challenge. The role of effective M&A integration interoperability strategies is pivotal, ensuring seamless data exchange, cost reduction, and improved patient care post-merger. Successful interoperability fosters transparent data sharing among regional operations, facilitating decision-making and enhancing efficiency. Passionate about the subject! If your organization is going through some changes, I would love to chat to discuss more. Feel free to reach out anytime! #HealthcareInnovation #Interoperability #FutureOfHealthcare #MandAIntegration #HealthcareMergers

As MA enrollment doubles, payers, providers, and policymakers face challenges. Hospitals voice concerns over delayed and denied payments, with 62% of hospital CFOs finding it more challenging to collect payments from MA plans.  🔴 Top issues on this list to address: 📜 Payment Options:  Hospitals cannot afford to sever ties completely, with over half of Medicare beneficiaries enrolled in MA. However, there are growing concerns over MA plan coverage, including denied care, delayed payments, and increasing difficulties in collecting payments. To address these challenges, hospitals can reduce the number of insurers they contract with or establish their MA plans. They should focus on payer option strategies, carefully choose MA payers to work with and align with their financial goals. 💻 Prior Authorization:  Providers have requested that CMS analyze data on claims denied by MA plans and take enforcement action against plans not following the coverage rules set out by Medicare. CMS must bar MA plans from delaying or denying claims approved through electronic prior authorization. CMS has taken action on prior authorization, clarifying that MA plans must follow coverage guidelines set by traditional Medicare. CMS also guided MA plans using AI and prior authorization, ensuring algorithms comply with coverage decision requirements. 🌑 Two-Midnight Rule:  New regulations require plans to provide coverage for inpatient admissions when the admitting physician expects the patient to require hospital care for at least two midnights. This underlines the importance of hospitals improving patient stay documentation and being prepared for increased audits. Hospitals must take a proactive stance in response to these regulatory changes, emphasizing the urgency and necessity of action. Despite these challenges, Medicare Advantage remains popular among beneficiaries. The future of Medicare Advantage—and Medicare as a whole—depends on how providers, insurers, and lawmakers address these critical issues. The good fight continues!! Feel free to reach out to discuss your RCM Strategy 😊 #MedicareAdvantage #HealthcarePolicy #Medicare #Medicaid #Healthcare #HealthcareNews #HealthcareTrends #HealthcareInsights #HealthcarePolicyChanges #HealthcareReform #HealthcareReformNews #HealthcareReformTrends #HealthcareReformInsights #HealthcareReformChanges https://lnkd.in/gKVAzCy9

I enjoyed reading this article! (Shout out to Melissa James CPC, CPMA, CRC) Recently, I had the opportunity to evaluate AI platforms that are clinically trained and can assist with coding tasks. These systems are a step forward, with the potential to enhance coding production and accuracy and improve project visibility. However, it's important to remember that these platforms are not a replacement for human coders. The expertise of human coders is crucial for tasks such as common-sense reasoning and regulatory compliance. When AI and human coders collaborate, the benefits are undeniable. Productivity, accuracy, and visibility in risk adjustment programs all see a significant boost. Let's not just consider but actively work towards combining the strengths of AI and human coders for optimal outcomes in the healthcare industry. Industry benefits impacts to highlight: 👨💻 Improved coding efficiency 🌐 Enhanced population health management 💰 Regulatory compliance and accurate reimbursement ⏩ Empowered coders with better, faster, and more precise work   #RiskAdjustment #AI #Healthcare

Is your team drowning in a sea of backlog? Agile Pods might just be the answer you've been looking for. These small, versatile teams are designed to tackle specific projects and tasks head-on, leading to smoother processes, improved efficiency, and a reduction in your backlog. Drop us a message at [email protected] to see how we can lend a hand. #AgilePods #Efficiency #Teamwork #TakeITFurther #Pointwest

Discover the 5 pioneering tactics that are transforming Quality Engineering in the ever-evolving digital world. From harnessing the power of AI-driven testing to embracing agile methodologies, this article tackles the secrets to achieving unparalleled software quality. Stay ahead of the curve and explore the future of QA. Read the full article here: https://lnkd.in/gudBXGWw #QualityEngineering #DigitalTransformation #AgileTesting #Pointwest #TakeITFurther

Pointwest greets a Happy Easter to all those who celebrate! May we all be blessed with hope, happiness, and abundance. #EasterSunday #HappyEaster #holiday #TakeITFurther #Pointwest

The Alliance for Value-Based Patient Care applauds the Centers for Medicare & Medicaid Services (CMS) for launching the ACO Primary Care Flex Model. This model will allow ACOs to offer prospective population-based payments for primary care, enabling them to reduce health disparities and improve access to coordinated care.   This model marks a milestone in CMS’s mission to transition all Medicare enrollees to accountable care relationships by 2030. We look forward to continued work with CMS and expanding access to the model.   Read more from Jacqueline LaPointe in RevCycleIntelligence: https://bit.ly/3TmtxEY   #ValueBasedCare #ACO #Medicare