Amanda Lee

📢 Attention Risk Adjustment professionals! The April 26th V28 workshop is SOLD OUT. But don't worry, tickets are still available for May, June and July. During the workshops, we'll cover important topics such as managing HCCs, calculating risk scores for 2024 and 2025, and reviewing updated HCCs for V28. We'll also sharpen our auditing skills and take a deep dive into the grey areas and red flags of HCC coding and clinical documentation. Don't miss out on this opportunity to enhance your skills and gain valuable insights. Advanced Risk Management and HCC Coding for VBP Workshop Fri, 31 May 2024 9:30 AM EDT https://lnkd.in/gsBZRrPP   Advanced Risk Management and HCC Coding for VBP Workshop Fri, 28 Jun 2024 9:30 AM EDT https://lnkd.in/g7g-XRhi   Advanced Risk Management and HCC Coding for VBP Workshop Fri, 26 Jul 2024 9:30 AM EDT https://lnkd.in/gxN2WRUU #riskadjustment #medicareadvantage #ACO #valuebasedpayments

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New Online Course! CMS-HCC Risk Adjustment Model Version 28: Be Proactive What can you do to mitigate the impact of the Centers for Medicare & Medicaid Services (CMS) Hierarchical Condition Codes (CMS-HCC) risk adjustment model Version 28? This online course reveals a proactive approach to mitigating the potential negative impact of Version 28 through proper identification of diseases and conditions coupled with addressing, assessing, and properly treating those diseases. It follows clinical and coding guidelines to address diagnoses and conditions for which the risk adjustment factor has been eliminated or reduced. It does this through a disciplined approach of reviewing co-morbid conditions, alternative diagnoses, and improved specificity. In all cases, the primary purpose is to treat the patient's diagnoses and conditions to improve the quality of life for the patient. Learn more about this course at https://lnkd.in/eVmECiEs. #CMS #hcquality #patientcare

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Understanding Prior Authorization in Healthcare 🔍 Insurance companies use prior authorization to approve or deny coverage for a prescribed medication. 💡Prior Authorization ensures the medication is cost-effective and used appropriately, based on clinical guidelines, formulary status, and patient-specific factors. 🤝 Collaboration is key. Effective communication between healthcare providers, pharmacists, and insurers is crucial for a smooth prior authorization process. #Healthcare #Pharmacy #PriorAuthorization 

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Can digitisation solve medical billing challenges? Insurers struggle with unstructured claims data and manual processes, burdening admin teams. Hospitals prioritize hiring admin staff over tech investments, leading to complex billing with paper claims. Discover how MedoSync simplifies this with an intuitive portal, automating administrative tasks.

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Impact of Policy Changes on SNF Billing Let's know about how recent policy changes affect Skilled Nursing Facility (SNF) billing: 🔹Understand new reimbursement rules. 🔹Adapt to updated documentation requirements. 🔹Navigate changes in Medicare/Medicaid guidelines. 🔹Prepare for potential shifts in billing procedures. Ready to navigate these changes effectively? Let's discuss how they impact SNF billing practices today! Know more: https://bit.ly/452uyGo For more insights, Contact 24/7 Medical Billing Services for a free consultation at  888-502-0537 / info@247medicalbillingservices.com. #SNFBilling #HealthcarePolicy #MedicalBilling #MedicareBilling #HealthcareRegulations #SNFReimbursement #HealthcareFinance #BillingCompliance #MedicalBilling #LongTermCare #SkilledNursingFacilities #BillingUpdates #ReimbursementRates #SkilledNursingFacilityBilling #247MedicalBillingServices

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#EHR adoption is significantly lower among behavioral health providers than for other #healthcare service lines. One major barrier is #burnout and lack of confidence in non-tech-savvy staff’s ability to adapt to a new system. Learn how to develop an EHR training plan that works for everyone.

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👩‍⚕️ Prior Authorization Process for Cardiologists 👩‍⚕️ Are you a cardiologist facing challenges with the prior authorization process in the USA? Understanding the intricacies of prior authorization can help streamline your patient care and administrative tasks. ✨ Prior authorization is a vital step that ensures insurance coverage for specific procedures, medications, or treatments before they are performed or prescribed. ✨ To navigate the prior authorization process effectively, cardiologists should be aware of the required documentation, medical necessity criteria, and communication channels with payers. ✨ Collaborating with a dedicated prior authorization outsourcing provider can help cardiologists save time, reduce administrative burdens, and enhance patient satisfaction. ✨ By outsourcing prior authorization tasks, cardiologists can focus more on delivering quality care to their patients and improving health outcomes. ⚡️ Have you experienced challenges with prior authorization as a cardiologist? Share your insights and tips below! ⚡️ If you need Prior Authorization Outsourcing Services, visit our website at 🌐 https://www.staffingly.com 📧 support@staffingly.com 📞 Call Toll Free: (800) 489-5877 📱 SMS/Text : +1(347) 545-7070 #Cardiologists #PriorAuthorization #HealthcareProvider #MedicalBilling #InsuranceCoverage #PatientCare

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How did a #Medicaid health plan decrease A1c for members engaged in our program by 0.6 points compared to a 4.1 point increase for unengaged members? With our program to link members to care and provide medication support! For more on our impact, get the case study: https://lnkd.in/eEN75dzC

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👩‍⚕️ **Prior Authorization Process for Dermatologists** 🩺 Are you a dermatologist feeling overwhelmed by the prior authorization process for your specialized treatments? Understanding the ins and outs of prior authorization can streamline your practice and improve patient care. Here are some key points to consider: 1. **Documentation is Key**: Ensure all necessary patient information, medical records, and treatment justifications are included in your prior authorization request. Clear and detailed documentation can expedite the approval process. 2. **Know Your Insurance Plans**: Familiarize yourself with the specific prior authorization requirements of each insurance plan you work with. Different payers may have varying criteria and processes, so staying informed is crucial. 3. **Stay Organized**: Create a systematic approach to managing prior authorizations, keeping track of submission dates, follow-ups, and approvals. Utilizing technology or outsourcing services can help streamline this process. 4. **Utilize Clinical Guidelines**: Refer to evidence-based clinical guidelines when submitting prior authorization requests. Aligning your treatment plans with established protocols can strengthen your case for approval. 5. **Communicate Effectively**: Maintain open communication with insurance companies, conveying the medical necessity and urgency of the treatments you recommend. Effective dialogue can facilitate smoother prior authorization approvals. By following these tips, dermatologists can navigate the prior authorization process more efficiently, ensuring timely access to specialized care for their patients. Have you faced any challenges with prior authorizations in dermatology? Share your experiences below! 🌟 If you need Prior Authorization Outsourcing Services, visit our website at 🌐 https://www.staffingly.com 📧 support@staffingly.com 📞 Call Toll Free: (800) 489-5877 📱 SMS/Text : +1(347) 545-7070 #Dermatology #HealthcareProviders #PriorAuthorization #SpecializedCare #InsuranceCoverage

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🗣 HealthSherpa's FFM Reintegration The Centers for Medicare & Medicaid Services (CMS) has issued new guidance on correctly integrating FFM accounts with HealthSherpa for Agents. If you haven't received these instructions, please follow the steps below. 👇 1) Ensure you are logged out of the CMS Enterprise portal. https://lnkd.in/et64YmKf 2) Log in to your HealthSherpa for Agents account. https://lnkd.in/ebsnswFv 3)Navigate to your Settings page and select ‘Remove My FFM Account’ (refer to the screenshot below). 4) Reintegrate your FFM account. For more information on how to reintegrate your FFM account with HealthSherpa, visit this help page.https://https://lnkd.in/eQBJxh5R

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Improve resident care outcomes and enhance star ratings and survey outcomes – all with the actionable insights of MDS Intelligence. This solution is more than MDS scrubbing. Beyond ensuring MDS integrity and accuracy, the software guides users on necessary corrections and supports reimbursement success with a PDPM calculator to better understand PDPM potential. Plus, simplified quality reporting delivers benchmark comparisons at the state and national level, for your enterprise or by facility locations. Discover MDS Intelligence: https://ow.ly/YvPz50RkaPQ #HealthcareSoftware #SNFCareQuality #MDSAssessment

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Did you know that dysphagia treatments are covered by insurance? Coding & Billing for Dysphagia Services Under Medicare Contractor National Government Services: ASHA recommends that SLPs continue to use the correct swallowing/feeding evaluation and treatment CPT codes to submit claims to NGS for patients with a dysphagia diagnosis. Some examples include: 92526: Treatment of swallowing dysfunction and/or oral function for feeding 92610: Evaluation of oral and pharyngeal swallowing function 92611: Motion fluoroscopic evaluation of swallowing function by cine or video recording 92612: Flexible fiberoptic endoscopic evaluation of swallowing by cine or video recording 92614: Flexible fiberoptic endoscopic evaluation, laryngeal sensory testing by cine or video recording 92616: Flexible fiberoptic endoscopic evaluation of swallowing and laryngeal sensory testing by cine or video recording Please review ASHA’s website for Medicare coding rules and general coding guidance (https://buff.ly/4dLsk3r) for swallowing and feeding services. #dysphagia #dysphagiatreatments #privatepracticeslp #dysphagiaawareness #dysphagiatherapy #speechlanguagepathology #speechpathologist

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#MedicareSavingsPrograms vs. #Medicare Medical Savings Accounts: Is there a difference? While the programs sound similar, they're not the same. This guide can help the adults you serve understand the benefits of both.👇 https://lnkd.in/eWPWHzh3

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Inspiren = Clinical + Ops Data for Senior Care  🙌🙌 Hey senior living community operators, we know you’re juggling a lot of technology, from EMRs and falls detection to billing and workforce management systems. Do you have any stories about fragmented technology in senior care? Tell us about them in the comments. What if you could access operational and clinical data—and see how they impact each other—in a single, integrated solution? What if a product offered proactive insights to help you make better decisions about safety, staffing, and revenue … all in one? That’s what you get with Inspiren: Real-time data you’ve never had before, AI-driven fall prevention, and decision-grade insights about how to reduce staff burnout, improve workflows, and ensure revenue accuracy. We think tech should enhance human connection, not get in the way, so our AUGi devices collect data passively from the resident environment and augment your staff’s decision-making. Plus, there’s no new data entry for staff, who can stay focused on providing the best care. If you’re interested in hearing more about how Inspiren can help your community, get in touch with our Chief Clinical Officer, Mike Wang, at mike@inspiren.com. You can also read more about us on our website: https://lnkd.in/eUKsbThD. #Inspiren #TheOperatingSystemForSeniorCare #HumanCenteredAI #SeniorLiving #SeniorCare

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A hospice provider’s CAHPS (Consumer Assessment of Healthcare Providers and Systems) survey score is a crucial quality measure, often hinging on after-hours care. This is where IntellaTriage excels, significantly impacting these scores. The most significant challenge to patient experience is timely contact with a provider. The CAHPS survey emphasizes how often help is available during weekends, evenings, and holidays. IntellaTriage steps into this space with a team of licensed nurses, leveraging advanced integration and interoperability to offer innovative triage solutions tailored to each hospice provider. 1. Shorter Wait Times, Personalized Experience ⌛ Caring for a hospice patient is a 24/7 responsibility, affecting both family and professional caregivers emotionally and physically. Immediate assistance is essential for managing symptoms, pain, and necessary supplies. IntellaTriage ensures calls are fielded by licensed nurses with an average wait time of under a minute. This responsiveness is crucial for a hospice’s CAHPS score, as caregivers need guidance irrespective of the hour. 2. Improved Patient Care ↗️ IntellaTriage supports nationwide hospices of all sizes, ensuring each patient receives focused care. Many hospices now require nurses not to field calls while bedside, improving the experience for patients and families. IntellaTriage’s on-call nurses handle these calls, ensuring continuity of care and allowing field nurses to concentrate on in-home care, leading to better experiences and improved CAHPS scores. 3. Better Quality of Life for Field Nurses 👩‍⚕️👨‍⚕️ Burnout is significant for hospice nurses due to their physically and emotionally demanding work. IntellaTriage alleviates this by handling 60-80% of after-hours calls, reducing workload and stress on field nurses. This decreases nurse turnover, enhances job satisfaction, and allows nurses to focus on patient care without handling calls. Nurses appreciate this support, often stating it significantly improves their work-life balance and job satisfaction. Ready to enhance your CAHPS scores and provide unparalleled support to your team? Schedule a strategy session with us today to learn more about our innovative solutions tailored to your unique needs. Contact us now to get started! https://bit.ly/3VmW7qs

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Earlier this year, Centers for Medicare & Medicaid Services provided guidance encouraging #PACE organizations to start submitting risk adjustment data using the Encounter Data System.   Will the transition impact program risk scores or reimbursement? Read our blog post to find out and get answers to other key questions.   👉Learn more: https://lnkd.in/eQ4dTmCQ #RiskAdjustment #ValueBasedCare

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How do providers manage the affordability issue for themselves and their patients? Learn more about addressing the health care affordability gap on The Scope: https://ow.ly/2aRk50S7qie

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🌟 Important Update for Healthcare Providers: CQC’s New Draft Business Plan and Regulatory Model 🌟 Attention Healthcare Providers, Antler Care wants to bring to your attention significant updates from the Care Quality Commission (CQC) that could impact your operations. The CQC's DRAFT Business Plan 2024-2027, presented at the May 2024 CQC Board Meeting, introduces several new performance indicators aimed at enhancing regulatory practices. ⚡ "Key Performance Indicator: Age of Registered Service Ratings" CQC is committed to ensuring that 75% of service ratings are less than five years old. This means that while the majority of ratings will be up-to-date, up to 25% may be older than five years. This approach balances the extensive scope of CQC's regulatory responsibilities with their goal of maintaining current and accurate assessments. ⚡ "Prompt Reassessment for Non-Compliance" For providers assessed under the Single Assessment Framework and found to be in breach of regulations, CQC is implementing a more rigorous and timely reassessment process. According to the CQC’s Regulatory Model Assessment Handbook (January 2024): 1. Action Plan Submission: Providers must submit an Action Plan within 28 days detailing how they intend to address the breach. 2. Responsive Assessment: If the Action Plan is deemed adequate, CQC will schedule a responsive assessment no later than one month after the provider’s planned compliance date. This assessment will revisit the same evidence categories to ensure comprehensive follow-up and verification of compliance. ⚡ "Commitment to Continuous Improvement" This revised approach underscores CQC's commitment to being a more dynamic and responsive regulator. Unlike previous practices where reassessments could be delayed for years, CQC now promises timely follow-ups, ensuring that compliance and service quality are consistently monitored and improved. We advise all registered providers to stay informed about these updates and prepare accordingly for more frequent and timely CQC assessments. At Antler Care, we are dedicated to providing you with the latest updates and guidance to help you navigate these regulatory changes successfully. Follow us for more updates and insights on CQC regulations and how they affect your services. Together, we can ensure the highest standards of care and compliance. #CQC #Healthcare #Regulation #Compliance #HealthCareProviders #AntlerCare #QualityCare Sources: Care Quality Commission, "Our new assessment approach: update January 2024" Care Quality Commission, "Starting our new assessment approach" Care Quality Commission, "CQC's new regulatory model"

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