Payer perspective: A conversation with Colleen Gianatasio

CDI and coding professionals typically recoil from the dreaded word, “payer.” After all, provider-payer relationships are often adversarial at best, hostile at worst. Clarify the diagnosis or procedure with the physician, apply the medical code … only to have the payer downcode or outright deny the claim.    My guest on today’s podcast understands the frustration…

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Explosive growth of Medicare Advantage covered lives requires organizational mindset shifts

medicare advantage

By Jason Jobes, SVP Consulting How do you incorporate the growth of rate of Medicare and/or Medicare Advantage in your organizations operational plans? Do you monitor changes in market share when considering population changes moving forward? As of April, 2023 there are 64.4 million Medicare beneficiaries in the country. This has grown from 57.9 million…

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Positive or negative reinforcement… which works best? HAC and HRRP vs. Meaningful Use

aha

By Brian Murphy The recent release of the 2024 IPPS proposed rule got me thinking about the Hospital Acquired Condition (HAC) and Hospital Readmissions Reduction (HRRP) programs. Both are built upon the precept that hospitals will respond positively to the threat of penalties by improving their quality of outcomes. Quick refresher on these programs: Hospitals…

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