BHM Healthcare Solutions’ Post

Succeeding in at-risk alternative payment models requires cost transparency awareness at the point of specialist care initiation and subsequent post acute care management. That knowledge translates to narrower spend variations in episode-of-care delivery within patient populations matched by disease severity. BPCI can prove to be a significant first step engagement in at risk contacting prior to the proposed CMS mandatory episodes and value-based referrals impacting specialist group practices in the coming years.

🌟 EXCITING NEWS FOR PHYSICIANS! 🌟 In light of recent challenges faced due to the cyber-attack on Change Healthcare, the Centers for Medicare and Medicaid Services (CMS) is stepping in with a lifeline for impacted physicians! 🚑💻 CMS has announced a NEW OPPORTUNITY for physicians to request advance Medicare payments. This initiative is aimed at alleviating cash flow disruptions and ensuring that healthcare services continue smoothly. 💡💸 Don't let financial hurdles slow down your invaluable services. Check out the full details of the program, understand the terms, and learn how to apply through the links provided below. Seize this chance to stabilize your practice during these challenging times! 👉 https://lnkd.in/eQRpHUbG 👉 https://lnkd.in/eMi7ByKj #HealthcareHeroes #CMSUpdate #MedicareSupport #PhysicianAid #CyberAttackRecovery

Keeping the dialog open on improving/reducing denial rates--it's important to know what's wrong so we can approach solution dialogs: Fifty-four percent of denials from private payers that were initially denied were ultimately overturned and paid, "but only after multiple, costly rounds of provider appeals," according to a March 21 report from healthcare solutions company Premier.  Premier conducted a survey of hospital and health system leaders representing 516 hospitals across 36 states between Oct. 10 and Dec. 31, 2023. The respondents were asked to consider all claims from Jan. 1 to Dec. 31, 2022. Here is the percentage of initial denials overturned, by payer type, according to the report:  Commercial: 60.5% Medicare Advantage: 52.7% Managed Medicaid: 49.7% Medicare: 50% Medicaid: 45.8%

CMS Says Nearly Half Of Medicare Fee-For-Service Beneficiaries Are Covered Under ACOs Modern Healthcare (1/29, Bennett, Subscription Publication) reports, “Medicare fee-for-service accountable care organizations are thriving, according to the Centers for Medicare and Medicaid Services.” Almost “half of fee-for-service Medicare beneficiaries, or 13.7 million people, are covered under ACOs this year, a 3% increase, the agency said in a news release.” According to the article, “in 2021, the innovation center declared a goal to have all fee-for-service Medicare enrollees associated with accountable care arrangements by 2030. Since then, CMS has undertaken steps to attract more providers and encourage more ACOs to form.” https://buff.ly/3HBEP2u

Over 100 hospitals, health systems, and providers have jointly advocated for enhanced Centers for Medicare & Medicaid Services oversight regarding Medicare Advantage (MA) denials. Premier Inc., a leading healthcare services company, spearheaded the initiative, urging CMS Administrator Chiquita Brooks-LaSure to mandate thorough data collection on MA claim denials and enforce compliance with Medicare coverage guidelines.   Premier's survey findings underscored the severity of the issue, revealing that while 15% of claims to private payers are denied, Medicare Advantage claims face a slightly higher denial rate of 15.7%. Moreover, hospitals incur an average administrative cost of $47.77 per appeal for denied Medicare Advantage claims.   In their letter to CMS, the healthcare entities emphasized the importance of monitoring MA plans' expenditure on direct patient care to ensure alignment with beneficiaries' entitlements. Notable healthcare providers, including CommonSpirit Health, Ascension, and AdventHealth, joined the call for CMS action.   Our RCM team plays a vital role in supporting hospitals by analyzing denial patterns, identifying underlying causes, and implementing effective strategies to minimize denials. Leveraging our expertise in Medicare Advantage regulations, we facilitate efficient appeals processes and advocate for fair reimbursement, ultimately striving to alleviate financial burdens on hospitals and uphold patient care standards.   We are the One!   #revenuecycle #revenuecyclemanagement #priorauthorization #medicalbilling #medicalcoding #healthcare #healthcaretechnology #accountsreceivables #denialmanagement #consulting #management #implementationpartner Becker's Healthcare

On November 2nd, The Centers for Medicare & Medicaid Services (CMS) released the final 2024 Medicare Physician Fee Schedule (PFS) ruling. New on the blog, MMG's Ronnen Isakov breaks down the changes and their impact on providers: https://lnkd.in/gHb8QxHD #medicare #healthcare #healthcaremanagement #healthcarebilling

The 4/22 Healthcare Labyrinth Blog is live. Click below to read. After major rules on Medicare Advantage, CMS has now finalized major changes impacting Medicaid and managed care plans. #healthcare #healthcarereform #healthinsurance #healthcarelabyrinth

The 4/22 Healthcare Labyrinth Blog is live. Click below to read. After major rules on Medicare Advantage, CMS has now finalized major changes impacting Medicaid and managed care plans. #healthcare #healthcarereform #healthinsurance #healthcarelabyrinth

The fact that CMS is intervening as a means to sustain healthcare services lets you know the affects of this breach will leave ripples for a long time. It’s time to pull up your sleeves to do what you can to help your organizations stay above water. #medicare #medicalbilling #aapc #reimbursement #medicalbillingandcoding

Great reminder from CTAC on the value of Advance Care Planning to Medicare Advantage Medicare Star Ratings. And always important - how we can support the voice of individuals to be the center of all healthcare plans. https://lnkd.in/gzq9wkgC