Medicare and Medicaid are two separate and commonly misunderstood programs, even among healthcare professionals. Centauri Health Solutions wants to help clarify the differences. Medicare was designed to protect people in retirement. Originally, it included Part A, which is hospital insurance, and Part B, which covers medical care outside of a hospital admission. Medicare pays the…

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The 2021 Poverty Guidelines were posted today at https://aspe.hhs.gov/poverty-guidelines and in effect as of January 13, 2021. The Federal Register notice for the 2021 Poverty Guidelines will be published the week of January 18 through January 22, 2021. Payers and Providers wait for the release of the poverty guidelines each year to update patient financial…

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Effective January 1, 2021, hospitals are required to post standard charges in a machine-readable file and post their negotiated rates online for 300 “shoppable” services, 70 of which are pre-selected by the Centers for Medicare and Medicaid Services (CMS). “Standard charges” include the gross charges, payer-specific negotiated charges, the amount the hospital is willing to…

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Perhaps you have more questions than answers about the Social Determinants of Health, such as: Why are social determinants important? Should I look at the community at large or individuals? Where do I start? How do I know if my patient or member population has unmet needs? What is a Z Code? How much money…

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Printed materials, educational question and answer sessions, and dedicated, live resources are all part of my employer-sponsored insurance (ESI) annual open enrollment experience. I take advantage of this enrollment assistance each year and would be lost without it. The same holds true for the hospital patients and health plan members Centauri Health Solutions (“Centauri”) assists…

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There have been a lot of changes with HEDIS® for MY2020.  We’ve highlighted key changes in the Volume 2 specifications until the final changes become available on October 1. The first change to note is that NCQA has instituted a new naming convention to reduce confusion about the measurement year vs. reporting year. Going forward,…

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CLICK TO VIEW INTERACTIVE VISUALIZATION The implementation of the Affordable Care Act (ACA) significantly changed insurance regulation in the individual and small-group health insurance markets. The ACA included a budget-neutral risk-adjustment program intended to prevent adverse selection by transferring payments to insurers who have higher-risk enrollees as reflected in their claims and supplemental data submitted…

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Note: Since publication, the Public Health Emergency (PHE) has been extended to April 20, 2021. “Unprecedented” is a word you hear frequently these days and for good reason. Never in our lifetimes has the world experienced what is happening right now with the COVID-19 pandemic and its implications. This is especially true when it comes…

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The COVID-19 pandemic of 2020 created an unprecedented time of mass closures…businesses, sporting events, school systems; you name it, it is likely closed. However, the business of healthcare is certainly not closed and nor are the businesses that support every aspect of it, including revenue cycle operations. These operations include risk adjustment, and risk adjustment…

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The 2020 poverty guidelines were released and published in the Federal Register with an effective date of January 14, 2020.   Payers and Providers wait for the release of the poverty guidelines each year to update patient financial assistance and eligibility information within their systems and forms. Controversy has surrounded the poverty guidelines and, more…

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