Author's posts
Information blocking could affect provider payment, MIPS and MSSP participation
Providers face monetary disincentives for violating information blocking, under a proposed rule released today by the Department of Health and Human Services.
Clarity and more timely results proposed for Independent Dispute Resolution process
A proposed rule pertaining to the controversial No Surprises Act Dispute Resolution process, would, if finalized, require payers to provide additional information at the time of initial payment or notice of denial of payment.
The proposals aim to incr…
HIMSSCast: Getting to value through the right data
Clinical decision support, such as what is offered by Wolters Kluwer, handles the avalanche of information providers and physicians need to stay informed.
The information services company has a team of over 7,000 physician editors – specialists in the…
Bipartisan lawmakers tell HHS to reconsider nursing home staffing mandate
Ninety-one bipartisan members of Congress have joined in objecting to a Centers for Medicare and Medicaid Services proposed rule for minimum staffing levels at nursing homes.
Medicaid redeterminations have cost Centene 1 million members so far
Centene, the largest Medicaid managed care organization in the country, is down over 1 million members since March, according to CFO Drew Asher during the company’s third quarter earnings call on Tuesday.
AI can improve the revenue cycle but increases risk, Moody’s says
Artificial intelligence has the potential to improve revenue cycle operations, optimize labor through administrative efficiency and lower operating costs, but it comes with the risk of cybersecurity attacks and patient data breaches, according to Moody…
Three quarters of ACOs in direct contracting model earned savings
The Global and Professional Direct Contracting Model for Performance Year 2022 saved the Centers for Medicare and Medicaid Services $371.5 million and saved direct contracting entities $484.1 million, according to the agency’s first evaluation report o…
HIMSSCast: Physician groups unite on accountable care
Susan Dentzer, president and chief executive officer of America’s Physician Groups, keeps pushing the needle on value-based care.
Ten health systems invest in Capital Rx’s backend claims processing platform
Ten health systems, including Banner Health, Memorial Herman and Ochsner Health, with digital health equity company Transformation Capital, have invested over $50 million in Capital Rx, a full-service pharmacy benefit manager and pharmacy benefit admin…
Medicare Advantage star ratings this year represent ‘final fallout’ from COVID-19
Fewer Medicare Advantage plans made the 5-star rating for 2024, and there were surprises among those that were on, and off, the MA and Part D list this year.
Gone from this year’s 5-star list were Kaiser Permanente’s Kaiser Foundation Health Plans. The…
