Randy Iskowitz

Need clarity on Medicare vs. Medicare Advantage? Our blog explains the key differences and discusses potential reforms. Read more: https://buff.ly/4aRNomO #LuminaImaging #clearchoice #CutHealthcareCosts

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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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According to the news published by HFMA on April 4, 2024, concerning Medicare Advantage states that CMS has finalized a slight decrease in the 2025 payment rates for Medicare Advantage (MA), potentially leading to constrained revenue and payments for stakeholders. While average revenue for MA plans is expected to rise by 3.7%, primarily due to an increase in the risk-score trend, base payments from Medicare to plans are slated to decline by 0.16%. Despite stakeholder comments seeking a more positive adjustment, CMS believes its policies will maintain stability for the MA market and beneficiaries, ensuring accurate payments and preventing wasteful spending. CMS also disagrees with the idea that this update represents a payment cut that would increase costs or reduce benefits for beneficiaries, citing the 3.32% net updates for 2024, and a significant decrease from the 8.5% increase in 2023. CMS asserts that plan availability, enrollment, and benefit offerings have remained stable or improved this year. Read More: - https://lnkd.in/giSgidsV

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Among the tools health systems can leverage to improve their performance under value-based care contracts, integrated health system specialty pharmacy can be particularly impactful. Join Nicholas Bull, Clinical Director of Population Health, and Lillian Piz, Manager of Population Health, as they dive into how health systems can advance their population health and value-based care objectives while increasing the quality of pharmacy care patients receive. #PQA24 #PopulationHealth #ShieldsRx #ValueBasedCare

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CMS recently updated MLN8659122 Original Medicare vs Medicare Advantage to include some updated payment rules for patients enrolled in Medicare Advantage (MA) plan. The updates include guaranteed reimbursement for Federally Qualified Health Centers, clarity of Hospice and Palliative care under the Value-Based Insurance Design Model, Home Health patients transitioning between original Medicare and a MA plan DMEPOS and supplemental mental health benefits. Of note for Home Health: “If patients enroll in an MA plan during the 30-day period that includes all home health services, CMS will proportionately adjust the 30-day period payment with a partial payment adjustment since the patient is receiving coverage under MA. Starting with the effective date of enrollment, the MA plan will get a capitation payment for covered services. In cases where a home health agency knows in advance that a patient will become enrolled in an MAO as of a certain date, submit a claim for the shortened period before the MAO enrollment date and code the claim with patient status 06.” See the link here for the full details: https://lnkd.in/ex6TtQzs #homehealth #consultants #managedcare #HH #postacute

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Gain Germane Solutions' insights into how the recently released 2025 Medicare Inpatient Prospective Payment proposed rules will impact GME funding here:

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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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This AEP is expected to be extremely disruptive to all Medicare patients. The Inflation Reduction Act and new CMS Final Rules have caused shockwaves across insurers. MAPD and PDPs are predicted to radically change benefits, premium, patient cost sharing, network participation, and some insurers will pull out of markets or specific counties. It is critical for every senior to assess their existing insurance this AEP and determine the impact on their cost, coverage, and access. You’ll help yourself and staff by referring patients to MedicareOnDemand before and during the AEP for an insurance assessment to ensure a smooth 2025 transition.

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Only 10% of those eligible for both Medicare and Medicaid are in integrated managed care plans, leaving many to navigate disjointed services. With the Centers for Medicare and Medicaid Services (#CMS) Medicare-Medicaid Program (#MMP) demonstration ending in 2025, the #MLTSS Association proposes building on the existing Dual-Eligible Special Needs Plan (#DSNP) framework to overcome integration barriers and boost enrollment. By focusing on necessary statutory and regulatory changes, we pinpoint priority areas and short- and long-term solutions in our proposal to increase more holistic and accessible care, enhancing the care experience for our most vulnerable populations. Read more about our policy proposals to advance integrated care: https://lnkd.in/eARMaV8m 

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The Great Reckoning in Medicare Advantage: Collaboration or Division? The landscape of Medicare Advantage is facing its biggest shift in two decades, according to McKinsey, which is presenting new challenges for payers and providers alike. As pressures mount, the vital question emerges: “How can health systems avoid getting the smallest slice of the remaining pie?” In a recent panel of payer and health system executives hosted by Strategy Catalyst, executives from both sectors discussed the future. The consensus? Those positioned to thrive in the impending Medicare Advantage "great reckoning" will be the innovators who foster collaborative efforts to optimize each other's cost structures. What might this entail? • Payers could seek to reduce their own cost-regulating denials and prior authorizations by trying to work collaboratively, focusing on efficient data sharing and solution-driven dialogues with providers. • Providers could streamline contracts to only work with those seeking mutual value, guided by well-defined principles for selecting partners and governing contract performance. Potential collaborative areas: • Jointly deciding on supplemental benefits that will be high impact of the population and promoting their utilization through the health system's medical group. • Establishing joint quality measures that would allow movement to prospective payment systems. • Exploring evidence-based care guidelines that could be agreed upon jointly to reduce administrative burdens, like unnecessary prior authorizations. Join the conversation and let us know your thoughts. For more detailed insights, ask for our two-pager on the future of Medicare Advantage.

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In this #CustomerStory, a top-5 Medicare health plan uses Authenticx to elevate CAHPS scores and Star Ratings to understand and improve the member experience. From listening to the actual voices of members and locating friction points to understanding how barriers impact care and plan satisfaction to updating their web portal and agent training, they saw: 📈 26% increased traffic to their web portal (more member-friendly self-service) ⏳ 300+ hours saved by agents due to an improved portal 💵 Almost $10K saved per month in agent efficiency Read the full story to see more #ROI and another customer story featuring a leading Fortune-500 payer organization that grew evaluations by 400% ⬇️ #UseCase #CaseStudy #Payer #Medicare #StarRatings #CAHPS #ConversationalAI #AIinHealthcare #ListenAtScale #Authenticx

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Medicare Advantage is evolving, and so are the implications for prior authorizations—a critical aspect of our work in patient access. Discover the latest changes and how they could impact millions: https://hubs.li/Q02CSfqt0 #HealthcareNews #PatientAccess #BCoD

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📌 The Battle For Medicare Advantage Star Ratings: SCAN and Elevance Victories Provide a Roadmap for Plans to Challenge CMS Methodologies 📌 ❇ In the world of Medicare Advantage, the calculation of Star Ratings is more than a measure of quality – it’s a pivotal marker that can significantly sway federal funding and market competitiveness. ✳ Against the backdrop of high financial stakes and rigorous scrutiny, recent legal victories for SCAN Health Plan and Elevance Health have charted a path in challenging Star Ratings methodology. ▶ Read more from Charles Baker, MHA, MSW about how these cases underscore the impact that Star Ratings have on the financial and operational aspects of Medicare Advantage plans. https://rb.gy/5zc924

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Each medical specialty faces distinct challenges, workflows, and patient demands. CareCloud offers specialty-specific solutions, empowering healthcare providers to streamline operations, make informed decisions, and deliver quality care tailored to their unique requirements. #CareCloud #Healthtech #ChronicCareManagement #RPM #RCM #Healthcare #Innovation #HealthcareInnovation #PatientCare #MedicalBilling

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Choosing the best clinical communication solution is foundational in efficient and effective healthcare delivery. But how do you decide? Our “Cheat Sheet” outlines the eight must-ask questions to guide your evaluation process when looking for a CC&C solution.​ 🔎Asking the right questions will help you select a solution that meets your organization’s needs and improves patient care delivery.​ Don't miss out on these insights. Download the eBook now and elevate your clinical communication.​ 🕮 Download the eBook​: https://buff.ly/4e9dYd9​ #ClinicalCommunication #Healthtech

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