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Good news for beneficiaries! Good news for Health Plans!!   On May 9, 2024,  CMS extended the Medicaid “unwinding” waivers into 2025. This means that the federal regulatory waivers and resulting options are now available until June of 2025. This continues to make available some of the methods states have been using to prevent administrative…

Introduction Health plans and providers need to ensure they understand their role in supporting CMS’ Strategic Plan related to the Quintuple Aim and the advancement of health equity, with an emphasis on data collection and reporting. The literature related to health equity frequently states that lack of data related to social determinants of health (SDOH)…

Even a cursory review of the latest healthcare news reveals that hospitals and health systems across the United States are looking to improve their financial outlook. With media headlines touting another round of layoffs at many health systems, the question becomes: Where and how can revenue cycle vendor partners step up to the plate and…

  Hospitals are operating in a world where they are being crushed by labor costs.  I talk to CFOs daily that describe unsustainable labor models they have been forced into.  As a result of this financial stressor, hospitals must scrutinize other costs, looking for savings.  Hospitals must purchase sutures, oxygen, and other mission critical needs,…

It has been a busy six months in the Medicare Advantage (MA) risk adjustment space, with plenty to keep the industry’s best and brightest thinking about what changes are in store for PY 2024 and beyond related to the risk model transition from v24 to v28, and the RADV Final Rule. Much of this prodigious…

Every hospital relies on a network of relationships with a variety of partners, including their patients and their support networks, local independent and employed physicians, state and federal organizations, payors, and many others. One of the most important relationships in driving growth, as opposed to other facility goals, is that with the local referring physician…

Hospitals have a rational interest in standardizing prices across facilities.  This interest has only intensified with the introduction of Price Transparency requirements. The goal of standard pricing must be considered simultaneously with other goals such as price stability and changes in gross and net revenue. There are several complexities in this analysis that must be…

Payors and Providers wait for the release of the poverty guidelines each year to update patient financial assistance and eligibility information within their forms and systems. The 2023 Poverty Guidelines are effective January 16, 2023, and are now posted HERE. Poverty guidelines are issued each year in the Federal Register by the Department of Health and Human Services…

Starting with the January 2023 payment month, health plans will see the impact of dual status on their End-Stage Renal Disease (ESRD) members change from prior years. In 2023, CMS implements the changes to the ESRD payment models that were announced in the 2023 advance notice. The revised ESRD payment model is calibrated on more…