Category: Healthcare News

Medicare Advantage Market

Medicare Advantage Market Trends: Growth, Challenges, and Opportunities

Medicare Advantage (MA) has become a dominant force in the Medicare landscape, accounting for over 54% of overall Medicare enrollment. This trend is expected to continue, with penetration rates projected to reach 64% by 2033.  However, the future of the Medicare Advantage market is not without its challenges. The Slowdown Begins While MA has experienced […]
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value-based contracts

Reducing Quality Measure Overload in Value-Based Contracts for Primary Care Physicians

With the proliferation of quality measures in value-based contracts, many primary care physicians feel overwhelmed and set up to fail. Research conducted at the healthcare system shows that these clinicians are inundated with an excessive number of quality metrics, often leading to administrative burdens and reduced patient care. One of the primary criticisms of value-based […]
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Financial impact of VBC

Navigating the Financial Impact of Value-Based Care (VBC)

The financial impact of VBC is profound, necessitating adjustments in how providers approach and manage their financial operations to align with this new model of care. The healthcare industry is shifting towards value-based care (VBC), a model that prioritizes high-quality care while aiming to lower costs. In contrast to the traditional fee-for-service model, value-based care […]
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Inflation Reduction Act

Medicare Prescription Drug Benefit Premiums Spike Amid Inflation Reduction Act Changes

Inflation Reduction Act: A Double-Edged Sword for Medicare Beneficiaries: The Biden administration’s recent announcement of the first Medicare drug price cuts, mandated by the 2022 Inflation Reduction Act, has dominated headlines. However, another significant impact of this law—substantial premium hikes for some Medicare beneficiaries—has largely been overlooked. The Inflation Reduction Act represents the most sweeping […]
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Value-Based Care challenges

Value-Based Care: Navigating Challenges and Opportunities in Revenue Cycle Management

RCM and Value-Based Care Challenges and Opportunities: Healthcare is a dynamic field constantly evolving to improve patient and staff experiences. As the industry transforms, it’s crucial to understand both the potential benefits and drawbacks of these changes. One area experiencing significant evolution is Revenue Cycle Management (RCM). The shift towards value-based care models is a […]
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Reimbursement-methodology

Understanding Medical Codes and Reimbursement Methodologies

The Role of Medical Codes in Reimbursement Methodologies: Medical codes, such as CPT, HCPCS, and ICD-10 (CM and PCS), are essential components of various reimbursement methodologies. The Inpatient Prospective Payment System (IPPS), used by Medicare fee-for-service, categorizes patient stays into Medicare Severity Diagnosis Related Groups (MS-DRGs) based on ICD-10 codes processed through a computerized system. […]
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impact urology practices

Medicare Physician Fee Schedule 2025: Urology Practice Impact

urology practices: The Centers for Medicare & Medicaid Services (CMS) unveiled its proposed Medicare Physician Fee Schedule for 2025 on July 10, 2024. This outlines potential payment adjustments and policy changes that would take effect starting January 1, 2025. A public comment period will follow, during which CMS will gather feedback to inform the final […]
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Medicare payment rules 2025

CMS Unveils Proposed Rules Impacting Medicare Payments for 2025

The Centers for Medicare & Medicaid Services (CMS) has unveiled a series of Medicare payment rules that will dramatically impact Medicare payments for 2025. These changes encompass payment rates, coding guidelines, coverage criteria, and quality measures for various healthcare providers. Physicians, in particular, face a proposed average payment rate cut of 2.93% under the fee […]
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Medicare payment cut

Medicare Payment Cuts Hit Physicians: 2.93% Reduction in 2025

Medicare payment cut: The Centers for Medicare & Medicaid Services (CMS) has released its proposed rule for the 2025 Medicare Physician Fee Schedule (MPFS), which includes a 2.93% average payment rate reduction for physicians. This comes despite the agency’s stated commitment to advancing health equity and supporting whole-person care through initiatives like strengthening primary care […]
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