Healthcare IT Today

OCTOBER 26, 2024

Read more… It’s Time to Combat “Instafraud” in Medicare Advantage. Read more… This Week’s Health IT Jobs for October 23, 2024: Multiple organizations with systems analyst roles to fill. In the wrong hands, LLMs can generate false or exaggerated medical documentation in an instant.

Ransomware 95

Ransomware Fraud Licensing Nurses 95

Healthcare Dive

NOVEMBER 30, 2023

UnitedHealth’s MA growth could be depressed next year thanks to a rate notice from the CMS that’s deeply unpopular with insurers, management said during their investor day.

Medicare 301

Medicare Medicare 301

Healthcare Dive

FEBRUARY 7, 2024

The insurer on Wednesday joined its peers in slamming proposed MA payment rates as insufficient given the dogged increase in medical costs.

Medicare 284

Medicare Medicare 284

Healthcare IT Today

OCTOBER 19, 2024

John summarized a study in the American Journal of Managed Care highlighting how real-time interventional analytics reduced 30-day readmissions and Medicare spending per beneficiary for Penn Medicine affiliates. Read more… Healthcare IT Today Podcast : HLTH 2024 Conference Preview.

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Health Insurance Medicare Medicare Hospitals 94

Healthcare IT Today

NOVEMBER 30, 2024

Five million Americans need to find new Medicare plans in 2025. Read more… This Week’s Health IT Jobs for November 27, 2024: Multiple roles in informatics and information management, plus California’s Clinicas del Camino Real seeks a Chief Medical Officer.

Medicare 93

Medicare Medicare 93

Healthcare Dive

FEBRUARY 20, 2024

The big question coming out of the health insurance earnings season is how much elevated utilization among seniors will carry over into 2024.

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Medicare Medicare Health Insurance 313

Compliancy Group

DECEMBER 20, 2024

In 2024, the Department of Health and Human Services (HHS) Office for Civil Rights announced a series of enforcement actions against entities that violated, or potentially violated, one or more HIPAA rules. This HIPAA 2024 Year in Review article discusses these actions. The $950,000 settlement agreement subjects HVHS to a 3-year CAP.

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Ransomware HIPAA Fraud Electronic Medical Records 98

Healthcare Dive

OCTOBER 30, 2024

Despite the stronger membership, Humana doesn’t expect earnings growth next year due to significant investments the insurer plans to make to boost MA stars.

Medicare 261

Medicare Medicare 261

Healthcare Dive

JANUARY 30, 2024

However, growth in Medicare's flagship shared savings model has plateaued over the past five years, according to government data.

Medicare 184

Medicare Medicare Governance 184

Healthcare IT Today

APRIL 4, 2025

Translation of member materials is an onerous burden for Medicare Advantage Organizations (MAOs). The 2024 CMS Final Rule extends this mandate, requiring that once a member in one of the supported language groups requests materials, they must be available on a standing basis.

Medicare 84

Medicare Medicare Medicaid Medicaid 84

Healthcare Dive

JANUARY 8, 2024

The payer is taking issue with how regulators calculated quality scores for 2024, after seeing a stars decline that could cause its bonus revenue to fall by $500 million.

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Medicare Medicare 293

Healthcare IT Today

NOVEMBER 13, 2024

Clinical Integration Analyst – North Memorial Health BI Developer – Phelps Health Director of Information Technology & Project Management – Pueblo Community Health Center, Inc.

Due Diligence 122

Due Diligence Medicare Medicare Hospitals 122

Healthcare Dive

JUNE 14, 2024

The redo comes after regulators lost two court cases over the methodology used to determine 2024’s quality ratings, and should result in hundreds of millions of dollars in additional bonuses to plans that see their ratings improve.

Medicare 274

Medicare Medicare 274

Healthcare Dive

NOVEMBER 2, 2022

Beginning in January 2024, ACOs that don’t have experience with performance-based risk will be able to stay in a one-sided risk arrangement for up to seven years before transitioning to two-sided risk.

Medicare 293

Medicare Medicare 293

HealthIT Answers

JANUARY 15, 2025

The Hospital Quality Reporting System is now open and accepting calendar year 2024 Medicare Promoting Interoperability Program data submissions and attestations from eligible hospitals and critical access hospitals. The post HQR System Now Accepting CY 2024 Medicare PI Program Data appeared first on Health IT Answers.

Medicare 59

Medicare Medicare Hospitals 59

Fierce Healthcare

OCTOBER 13, 2023

Approximately 42% of Medicare Advantage plans that offer prescription drug coverage will have a star rating of four or more in 2024, marking yet another substantial decrease from

Medicare 126

Medicare Medicare 126

Healthcare Dive

DECEMBER 22, 2023

A shift in funding sources, new regulatory policies in Medicare and technology advances may influence M&A in the sector next year, according to Samantha Prokop from law firm Gunster, Yoakley & Stewart.

Medicare 269

Medicare Medicare 269

Healthcare Dive

MARCH 16, 2023

Updating base physician payment rates by 1.45% in 2024 as proposed by the group that advises Congress on Medicare policy is “grossly insufficient,” the Medical Group Management Association said in a statement.

Medicare 301

Medicare Medicare 301

Fierce Healthcare

MARCH 31, 2023

CMS to raise Medicare Advantage pay rates by 3.3% in 2024; phase in risk adjustment changes rking Fri, 03/31/2023 - 16:02

Medicare 135

Medicare Medicare 135

Fierce Healthcare

SEPTEMBER 26, 2023

Expect premiums, benefits and plan choices for Medicare Advantage (MA) and the Medicare Part D prescription drug program to look similar in 2024, the Centers for Medicare & Medicaid Services (C | CMS announced that nearly three-quarters of MA plan beneficiaries will not see their premiums rise.

Medicare 118

Medicare Medicare Medicaid Medicaid 118

Fierce Healthcare

AUGUST 13, 2024

Fifty-four percent of Medicare beneficiaries are enrolled in a private Medicare Advantage plan, and in seven states that figure tops 60%, according to a new report from KFF.

Medicare 130

Medicare Medicare 130

HealthIT Answers

AUGUST 29, 2023

By Chris Emper - On July 13, the Centers for Medicare & Medicaid Services released a 1,920-page proposed rule that would update payment policies and programs regarding Medicare payments to physicians and other providers under the Physician Fee Schedule on or after January 1, 2024.

Medicare 111

Medicare Medicare Medicaid Medicaid 111

HealthIT Answers

MARCH 11, 2025

This is notification that eligible hospitals and critical access hospitals participating in the Centers for Medicare & Medicaid Services Promoting Interoperability Program that there is an upcoming data submission deadline on March 14, 2025, at 11:59 p.m. Pacific Time.

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Medicaid Medicaid Medicare Medicare 59

Healthcare IT Today

DECEMBER 28, 2024

John and Colin looked back at an eventful year, with a focus on the people, places, or companies that make their notable list for 2024. Read more… Bonus Features for December 22, 2024: 83% of providers want virtual care to be a permanent part of their practice; meanwhile, Medicare home visits have dropped 17% since 2017.

Medicare 56

Medicare Medicare Hospitals 56

HIT Consultant

OCTOBER 22, 2024

Compounding these challenges is the recent introduction of the Healthcare Cybersecurity Act of 2024, which mandates collaboration between CISA and HHS to enhance the cybersecurity of the Healthcare and Public Health Sector. Two potential strategies for implementing these requirements include: 1.

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HIPAA Compliance Public Health Medicaid 139

Compliancy Group

JANUARY 31, 2025

The most shocking part is that the Change Healthcare breach wasnt the only massive breach in 2024. With 2024 behind us, its time to take a look at the years most significant breaches. On June 20, 2024, OCR updated its guidance after courts found a portion of its previous guidance unlawful. Not so shocking? The damage?

Ransomware 52

Ransomware HIPAA Medicare Medicare 52

Fierce Healthcare

JUNE 17, 2024

LAS VEGAS—The eyes of many regulators and lawmakers are on Medicare Advantage (MA), and, amid rising criticism of the program, one industry leader is making the case that "nostalgia" for traditiona | LAS VEGAS—The eyes of many regulators and lawmakers are on Medicare Advantage, and amid rising criticism of the program, one industry leader (..)

Medicare 110

Medicare Medicare 110

Fierce Healthcare

SEPTEMBER 16, 2024

billion in Medicare Advantage quality bonus payments, according to a new analysis from KFF. Health plans are set to rake in $11.8

Medicare 132

Medicare Medicare 132

MRO Compliance

FEBRUARY 3, 2025

HEDIS audits are important for Medicare and Medicaid health plans because data is used to determine the efficacy of a payer to care for its members. For Medicare Advantage plans, the HEDIS review process contributes to the Star Rating system, which evaluates plan quality. Explore the HEDIS MY 2024 Measure Descriptions Guide.

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Patient Satisfaction Compliance Medicare Medicare 147

Healthcare IT Today

DECEMBER 22, 2024

Access to home health for Medicare beneficiaries is decreasing , according to a recent report from Trella Health, with the number of home health visits per day down more than 17% between 2017 and 2023. That said, rejection rates hit a trough in 2018 and have increased 16% since then.

Medicare 88

Medicare Medicare FDA Telemedicine 88

Fierce Healthcare

MARCH 4, 2024

Medicare Advantage (MA) growth has broadly slowed, but the biggest players in this space continue to claim the lion's share of this expansion, according to a new report from healthcare consultant C | Medicare Advantage growth has broadly slowed, but the biggest players in this space continue to claim the lion's share of this expansion, according (..)

Medicare 121

Medicare Medicare 121

Healthcare IT Today

JANUARY 6, 2025

This funding will allow us to expand our commercial reach, which is especially germane following our recent achievements in attaining Medicare coverage and a CPT Category I code for advanced plaque analysis. As of June 30, 2024, the firm has over $80B in regulatory assets under management. Originally announced December 4th, 2024

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FDA Medicare Medicare 113

Fierce Healthcare

FEBRUARY 1, 2023

CMS proposes small hike to Medicare Advantage, Part D plan payments in 2024 amid risk adjustment changes rking Wed, 02/01/2023 - 17:35

Medicare 110

Medicare Medicare 110

Medisys Compliance

FEBRUARY 19, 2025

Billing Update: Medicare Radiology Reimbursement Cuts 2025 Effective January 2025, radiology practices nationwide are facing reduced Medicare reimbursements due to finalized changes in the Physician Fee Schedule. Now, in February 2025, these proposed rules are our current reality. Here are key steps you can take: 1.

Medicare 59

Medicare Medicare Medical Billing Outsourcing Medical Billing 59

Fierce Healthcare

JUNE 3, 2024

Blue Cross and Blue Shield of Kansas City is leaving the Medicare Advantage (MA) market at the end of 2024, the insurer announced recently. Blue Cross and Blue Shield of Kansas City is opting out of the Medicare Advantage market.

Medicare 124

Medicare Medicare 124

Healthcare Dive

FEBRUARY 11, 2025

The massive insurer now expects to lose 550,000 Medicare Advantage members — roughly one-tenth of its individual MA footprint — this year as a result of plan cuts.

Medicare 172

Medicare Medicare 172

Fierce Healthcare

JANUARY 12, 2023

MedPAC calls for slight pay update to 2024 Medicare rates for hospitals, physicians. Thu, 01/12/2023 - 14:33.

Medicare 98

Medicare Medicare Hospitals 98