Tag: Revenue Cycle Management

aha-calls-for-medicare-advantage-inclusion-in-prior-authorization-rule

AHA Calls for Medicare Advantage Inclusion in Prior Authorization Rule

The American Hospital Association (AHA) has asked CMS to include Medicare Advantage organizations in its proposed rule that would streamline the prior authorization process and reduce patient care delays. In December 2020, CMS released a notice of proposed rulemaking about improving prior authorization, following past administrative and clinician struggles. If the rule is finalized, there […]
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2022 Medicare Advantage Plan Overview, Part Three: Social Determinants

  “Medicare Advantage plans have a unique and growing opportunity to address the needs of socioeconomically vulnerable populations and improve their health,” reports America’s Health Insurance Plans. More plans for individuals with low incomes, as well as targeted SDOH investments and initiatives, round out carrier approaches. On the benefits side, offerings such as meals, transportation, […]
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more-medicare-advantage-plans-will-offer-non-medical-benefits-2022-finds-avalere

More Medicare Advantage plans will offer nonmedical benefits in 2022, finds Avalere

  More plans will offer meals, nutrition, transportation or in-home support services at a $0 premium in 2022. Ahead of the annual election period, which began on October 15, the Centers for Medicare and Medicaid Services published information on MA and Part D plan (PDP) premiums, benefit offerings and star ratings. Avalere analyzed that data […]
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most-medicare-beneficiaries-dont-compare-coverage-options-during-open-enrollment

Most Medicare beneficiaries don’t compare coverage options during open enrollment

Since not shopping around can have an impact on enrollees’ coverage and costs, CMS recommends they review and compare plans each year. The numbers are similar across both Medicare Advantage and traditional Medicare, with 68% of MA beneficiaries saying they don’t compare medical plans, and 73% of those in traditional Medicare claiming the same. The […]
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2022-medicare-advantage-plan-overview-part-two-portfolio-strategy-and-leading-carriers

2022 Medicare Advantage Plan Overview, Part Two: Portfolio Strategy And Leading Carriers

  The ideal value chain for any industry or company is one built for lifelong customer retention and loyalty. One component of such a chain is a portfolio strategy that continues to offer maximum choice and affordability. For insurers in the Medicare market, this equates to a mix of plan designs and standalone prescription drug […]
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schedule-online-visits-first-its-next-big-thing-health-insurance

The Schedule Online Visits First? It’s The Next Big Thing In Health Insurance

  At the height of the COVID-19 pandemic, people often relied on telemedicine for doctor visits. Now, insurers are betting that some patients liked it enough to embrace new types of health coverage that encourages video visits — or outright insists on them. Priority Health in Michigan, for example, offers coverage requiring online visits first […]
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Key Characteristics for Successful Downside Risk Contracting

Organizations that do strong vendor relationships, invest in the organization, and are willing to take on commercial risk will be poised to take on downside risk financial contracts. Through working with population health management vendors, KLAS released a recent report identifying which of their customers are most advanced in adopting downside risk contracts. In the […]
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leaders-say-efficiency-not-finances-top-rev-cycle-rpaai-benefit

The Leaders Say Efficiency, Not Finances, Is Top Rev Cycle Rpa/ai Benefit

More than 80% of leading health systems that are using RPA/AI say their primary reason for investing in the technology was improving financial performance, but once the technology was in use, they said efficiency was the top benefit. The reasons that leading health systems initially invest in robotic process automation (RPA) and artificial intelligence (AI) […]
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