Cotiviti’s Post

Did you know? According to the Centers for Medicare and Medicaid Services, healthcare spending in the United States makes up 17.7% of the Gross Domestic Product (GDP), representing the combined value of all goods and services produced by the nation in a given year. #business #healthcare

🎥Comparing US healthcare and GDPs of nations?🌍💰 Join Raphael Oesch, CFA in our Chart of the Month video as he delves into the latest healthcare cost estimates by CMS (Centers for Medicare & Medicaid Services). Get ready to be amazed by the numbers🚀 #ChartOfTheMonth #Healthcareinvestments

Staggering fact! On a standalone basis, the US healthcare system would be the world's 4th largest economy! Check out our latest Chart of the Month with Raphael Oesch, CFA. #healthcare #ChartOfTheMonth

A recent rule released by Centers for Medicare & Medicaid Services requires payers to send #PriorAuthorization decisions within 72 hours for urgent requests and seven days for standard requests. Impacted payers will be required to implement and maintain specific APIs that will improve the electronic exchange of healthcare data and streamline the overall prior auth process. Speeding and simplifying prior authorizations is our mission at Valer, and we are supportive of increased measures like this that require more health plan transparency and accountability. Read more about the rule here: https://hubs.la/Q02hd3CQ0

Value-based care has emerged as an alternative and potential replacement for fee-for-service reimbursement based on quality rather than quantity. Value-based care is a form of reimbursement that ties payments for care delivery to the quality of care provided and rewards providers for both efficiency and effectiveness. In order to transform how healthcare providers are reimbursed for services rendered, the Centers for Medicare & Medicaid Services (CMS) has itself introduced an array of value-based care models. Private payers have, in turn, adopted similar models of accountable, value-based care. Value-based care seeks to advance the triple aim of providing better care for individuals, improving population health management strategies, and reducing healthcare costs. In more basic terms, value-based care models center on patient outcomes and how well healthcare providers can improve quality of care based on specific measures, such as reducing hospital readmissions, using certified health IT, and improving preventative care. #valuebasedhealthcare #caremodels #patient #qualityofcare #improving #cricketstirlingandassociates #weloveinsurance❤️

Stay ahead in Arizona's healthcare landscape! Join The Hertel Report for curated weekly updates on Medicare Advantage, Medicaid, hospitals & health systems, and more. Elevate your knowledge, elevate your leadership. Become a member today! https://lnkd.in/gy7Vst5U #HealthcareLeadership #ArizonaHealthcare #HertelReport

More organizations are considering payer contract terminations due to dissatisfaction with reimbursement rates and overall bad payer behavior. Healthcare providers have been arguing for years that payers often set reimbursement rates at levels that are lower than the actual cost of providing care. Couple this with skyrocketing inflation costs and labor expenses, providers can be left with no other choice than to terminate. And what payer has been in the spotlight recently? Look no further than Medicare Advantage. Thanks to Britt Berrett and julie soekoro for all of your input on this piece (as well as many others). And to Scripps Health, St. Charles Health System, Samaritan Health Services, and Hamilton Health Care System for sharing your experiences with Medicare Advantage. #CFOs #medicareadvantage #payers HealthLeaders https://lnkd.in/ergb3hBk

Centers for Medicare & Medicaid Services (CMS) continually updates its policies to enhance service quality and accessibility. The latest CMS 2024 Physician Fee Schedule Final Rule presents significant adjustments with far-reaching implications for healthcare providers and patients alike. This rule brings a blend of challenges and opportunities, reflecting CMS's commitment to health equity and quality care. #CMS #PhysicianFeeSchedule #HealthcareBlog #HealthcareTrends https://lnkd.in/eYT-A-Z2

The lack of agreement among Medicare, Medicaid, and commercial health plans on which digital healthcare services should be covered is impeding the expansion of digital health in the medical field, according to a report by the American Medical Association (AMA). Medicare and Medicaid have specific guidelines for coverage, but commercial health plans vary widely in how they cover digital health codes, leading to confusion among physicians and patients. For example, Medicare covers six remote patient monitoring codes, while some commercial plans cover fewer or none of these codes, creating inconsistencies and uncertainty. The AMA emphasizes that bridging this "digital health disconnect" will require policy redesign and collaboration among stakeholders to maximize the potential benefits of digital health, including simplified administrative processes, better communication among specialists, and enhanced patient care. #DigitalHealth #Medicare #Medicaid #HealthcareCoverage #HealthcareTechnology #AMA #PatientCare #HealthcarePolicy #ValueBasedPayment #MedicalTechnology https://lnkd.in/gQVcJ4dx

In a letter to Centers for Medicare & Medicaid Services (CMS), NAACOS outlines key recommendations for improving the Medicare Shared Savings Program (MSSP) in the agency's rulemaking this year. To ensure that #Medicare ACOs are a strong and viable options for health care providers, NAACOS recommends that CMS: ✅ Recognize the fiscal realities of remaining in an alternative payment model (APM) and correct the benchmark ratchet. ✅ Leverage its authority to create strong nonfinancial incentives by removing burden from the quality reporting and beneficiary notification requirements. ✅ Support next generation innovation by offering primary care hybrid payment and an Enhanced Plus track. Read more in the letter: https://lnkd.in/eCPWWxbD #valuebasedcare #accountablecare #healthcareinnovation