Angelica Landers’ Post

Last week CMS approved a new rule that mandates government-sponsored healthcare plans to reduce their turn-around times for pre-approval requests. The new rule requires non-urgent requests to be completed within 7 days, while urgent pre-approval requests must be completed within 72 hours. The change hopes to increase the efficiency of the healthcare system and benefit patients. Its a win for patient satisfaction, 60% of positive Net Promoter Score feedback related to timeliness. Perception of timeliness includes both systems within and outside of the physician office. A high-performing target for prior authorization turn around time from a physician group practice is 24 hours, that PA sits elsewhere for weeks but perception of the delay falls on the physician. The intent to avoid unnecessary procedures through a PA is outdated and its finally acknowledged. While the new CMS rule is a step in the right direction, a primary care operation that invests in utilization management, patient navigation, and has a high acceptance rate of prior authorizations should not have to participate in the process at all. Reducing the waiting game from 8 days to 1 day can improve patient satisfaction and reduce healthcare costs. #CMS #healthcare #governmentplans #efficiency #patients

Ohio State & CVS Form ACO to Elevate Medicare Care in Central Ohio - HIT Consultant #OhioState & #CVS Form ACO to Elevate Medicare Care in Central Ohio Ohio State University Wexner Medical Center and CVS Health have formed an Accountable Care Organization (ACO) to improve healthcare outcomes for Medicare beneficiaries in Central Ohio. This collaboration aims to enhance care coordination, increase access to healthcare services, and improve the overall patient experience. #ACO Model and Medicare The ACO model is a value-based care approach that focuses on improving quality and reducing costs for Medicare beneficiaries. ACOs are groups of healthcare providers who work together to coordinate care and share accountability for the quality and cost of healthcare services. This model aligns with Medicare's goal of transitioning from fee-for-service to value-based care. #Benefits of ai.mediformatica.com #medical #accountablecare #this #health #medicare #medicarebeneficiaries #patientcare #theohiostateuniversitywexnermedicalcenter #chronicconditions #cvshealth #medicaresharedsavingsprogram #mssp #digitalhealth #healthit #healthtech #healthcaretechnology @MediFormatica (https://buff.ly/3Sc2UC2)

Maximizing Reimbursement: The Impact of Z-Codes in Inpatient Billing In the complex world of inpatient billing, Z-codes are emerging as a game-changer. These codes, part of the ICD-10 classification, capture social determinants of health that often go unnoticed but significantly impact patient care and outcomes. By accurately documenting these factors, healthcare providers can ensure comprehensive patient records, leading to improved care strategies and optimized reimbursement. The inclusion of Z-codes in billing practices not only reflects a holistic view of patient health but also aligns with value-based care models. As we move towards a more patient-centric healthcare system, understanding and utilizing Z-codes will be crucial for healthcare facilities to enhance patient care and maximize financial performance. #HealthcareBilling #ZCodes #PatientCare #ValueBasedCare

The CMS Final Rule 2023 brings significant challenges to physicians and healthcare facilities, with a 3.4 percent reduction in reimbursement alongside a reinstated 2 percent sequestration adjustment. This comes amid the highest-ever increase in the Medicare Economic Index (MEI), rising to 4.6 percent. The physician fee schedule sees an overall payment reduction of 1.25 percent, resulting in the lowest conversion factor since 1998 at $32.74. CMS introduces add-on code G2211 for specific situations with evaluation and management codes, addressing previous implementation delays. Additionally, the definition of a "substantive portion" in split visits aligns with CPT guidelines. For more details on the CMS Final Rule 2023 and its impact. To know more about the in detail about the add on code and for expert coding services Contact Zealous healthcare now! Visit: https://lnkd.in/gVgeVMmQ Email: [email protected] To know more: https://lnkd.in/gmDjrYFb #healthcareindustry #cms #zealoushealthcare #healthcareupdates #healthcareproviders #healthcareprofessionals #homehealthcareproviders

Exciting news for healthcare providers! Proposed changes to Remote Patient Monitoring (RPM) coding could revolutionize reimbursement by 2025. The American Medical Association's May CPT Editorial Panel meeting will discuss crucial updates, potentially expanding RPM coverage and flexibility. Currently, RPM services are billed under four CPT codes, but upcoming changes may introduce significant enhancements. Key proposals include: 1. Introducing a new code covering 2-15 calendar days of collected data, easing billing for shorter monitoring periods. 2. Revising codes to reduce minimum care management times, promoting flexibility and provider reimbursement. 3. Enhancing interactive communication code allowances, encouraging more patient engagement. These changes are anticipated to drive higher RPM adoption and program flexibility, benefiting both patients and providers. If approved, Medicare and private payers may follow suit, expanding coverage and potentially improving patient outcomes while reducing healthcare costs. Stay tuned for updates post the AMA meeting in May! #HealthcareInnovation #RPM #HealthcareCoding #MedicalBilling

The shift from fee-for-service to value-based care (VBC) is changing the healthcare landscape. Unlike traditional models, VBC emphasizes the quality of care and measurable scores. CCM supports this by providing continuous management of chronic conditions resulting in improved patient outcomes, increased revenue for physician practices, and cost savings for Medicare.  Read the full article here: https://rb.gy/ua5rqu #ChronicCareManagement #CCM #caremanagement #chroniccare #ValueBasedCare #RPM #remotepatientmonitoring

Value Based Care is the future... and the future is now.

In the complex landscape of healthcare, the intersection between patient care and administrative processes often presents significant challenges. My recent discussion with The New York Times shed light on a critical aspect of this intersection: the prior authorization process. This mechanism, intended to regulate healthcare costs and ensure appropriate treatment, frequently acts as a bottleneck, delaying necessary medical interventions and placing additional stress on patients and healthcare providers alike. The reality is that while prior authorization aims to serve as a checkpoint for cost control and care appropriateness, it can inadvertently prioritize paperwork over patient well-being. These delays can lead to exacerbated health conditions, increased hospitalization rates, and a higher overall cost to the healthcare system—outcomes that are the antithesis of the process's original goals. As a physician, I witness the direct impact of these delays on my patients. The time spent navigating these administrative hurdles is time taken away from patient care. It's imperative that we advocate for a reevaluation of the prior authorization process, focusing on strategies that streamline administrative procedures without compromising the quality of care. We must champion reforms that prioritize the health and well-being of patients. This includes advocating for transparency in the criteria used for authorizations, expediting approvals for routine and non-controversial treatments, and ensuring that healthcare professionals are at the forefront of decision-making processes regarding patient care. The path forward should be a collaborative effort among healthcare providers, insurers, and policymakers to devise a system that upholds the principles of timely, effective, and patient-centered care. Let's come together to advocate for a healthcare system that values patients over paperwork, ensuring that every individual has access to the care they need when they need it. #HealthcareReform #PatientCare #PriorAuthorization #MedicalEthics #HealthPolicy #FixTheSystem #FixThePriorAuth --- Thank you The New York Times for covering this important topic. https://lnkd.in/e4BvatM7 ETA: here is the YouTube link in case you are unable to access through NYT https://lnkd.in/e8ZKhnd9

The Impact of Healthcare Policy Changes on SMB Finances 📈 Navigating the evolving landscape of healthcare policy can be challenging for small and medium-sized businesses (SMBs). Recent policy changes have significant financial implications that every healthcare SMB owner should be aware of. The shift from fee-for-service to value-based care models aims to improve patient outcomes and reduce costs. According to CMS, value-based care models saved Medicare approximately $3.4 billion in 2020 alone. Policies expanding telehealth services have increased accessibility and reduced operational costs, with a McKinsey report finding that telehealth usage stabilized at 38 times higher than pre-COVID-19 levels, significantly impacting healthcare delivery and finances. New regulations requiring hospitals and insurers to disclose pricing information promote competition and potentially lower costs. A study by the Journal of the American Medical Association (JAMA) found that price transparency can lead to cost reductions of up to 7%. Additionally, expanded Medicaid coverage in several states has increased patient volumes for healthcare providers, with states that expanded Medicaid seeing a 15% increase in patient visits, translating to higher revenue for SMBs in healthcare. Staying informed about these changes is crucial for strategic planning and financial management. By adapting to new policies, healthcare SMBs can enhance their services, reduce costs, and improve patient satisfaction. How are these policy changes impacting your business? Share your thoughts and experiences with us! Seedium #HealthcareFinance #SMB #PolicyChanges #ValueBasedCare #Telehealth #PriceTransparency #MedicaidExpansion

Looking to elevate the level of care for your Medicare patients? 2Morrow Health Plus offers turn-key Remote Patient Monitoring (RPM) and Chronic Care Management (CCM) services to help improve patient outcomes and ensure that your patients receive the best care possible. By leveraging our people + technology, you can: • Provide personalized care plans • Monitor patient health in real-time • Proactively identify and address potential issues. 2Morrow Health Plus does all the heavy lifting: enrollment, provide the licensed clinical staff, devices, check-ins, feedback into EHR, as well as provide the clinical financial codes for proper billing. RPM and CCM services: • Reimbursable by Medicare (Up to $1,000 per year, per patient) • Excellent source of additional revenue for your practice • No start-up costs With our turn-key services, you can also save time and resources by streamlining care coordination and reducing hospital readmissions. To learn more about how 2Morrow Health Plus Health can help increase revenue for your practice, contact us at [email protected] and schedule a demo today! #RemotePatientMonitoring #ChronicCareManagement #MedicareServices #PatientOutcomes #IncreaseRevenue #2MorrowHealth #PatientHealth