CMS and other stakeholders take steps to improve prior authorization in Medicare Advantage and beyond
Several recent developments point to an industrywide effort to ease the burden of prior authorization. Most notably, CMS on April 5 finalized a rule that includes provisions designed to improve prior authorization in Medicare Advantage (MA) starting with the 2024 plan year. The rule addresses a few aspects of prior authorization, among them the way…
How to determine appropriate patient status and navigate observation-level care
The financial implications of ensuring appropriate patient status throughout a hospital stay are substantial, so it is in organizations’ interest to enhance the process.
Creating a sustainable healthcare workforce demands innovative solutions
Five healthcare leaders share insight on how their forward-thinking healthcare organizations approach staffing challenges facing the industry.
Healthcare News of Note: 100 hospitals receive funding for new physician residency slots to boost healthcare access
CMS distributed 200 Medicare-funded physician residency slots to 100 hospitals, aiming to bolster healthcare access in areas with a shortage of qualified professionals. Overall cancer mortality has dropped 33% since 1991, averting an estimated 3.8 million cancer deaths, according to the American Cancer Society’s latest report. Patients’ ratings of specialist care were markedly higher when…
Key points to know in recently proposed rules for Medicare Advantage and the ACA marketplaces
A proposed rule for health plans in Medicare Advantage has provisions designed to stem overreach in prior authorization processes.
Seeking to phase out Medicare DSH payments, MedPAC outlines potential changes to reimbursement for safety net providers
Revamped formulas for hospitals and physicians would be designed to better target payments to providers that treat larger shares of low-income Medicare beneficiaries.
New federal rule aims to eventually ease prior authorization processes
CMS is seeking to improve the prior authorization process in government programs such as Medicare Advantage (MA) and Medicaid, although the core provisions would not begin until 2026. The agency this week updated a Trump administration proposed rule with new proposals to “improve patient and provider access to health information and streamline processes related to prior authorization…
CareCredit healthcare credit card provides flexible payment options for both patients and healthcare providers
Read about one company's payment solution that gives patients a way to pay for out-of-pocket healthcare costs while enabling health care organizations to receive payment for services within two business days.
Three opportunities to improve the patient experience — before the patient steps in the door
Providing a positive patient experience requires attention at every encounter. With today’s staffing shortages, however, this can be challenging.
Revenue cycle automation helps health systems regain financial footing during COVID-19 and beyond
Bots and other forms of automation are helping hospitals keep up with the revenue cycle at a time when resources are limited.