Posts Tagged ‘medicare advantage’
Analysis of 17 OIG reports reveals compliance blueprints for Medicare Advantage and provider organizations
Part 1 of an ongoing series By Jason Jobes Today I am starting a series on my analysis of the 17 Medicare Advantage OIG reviews released from 2022-2023. Given the rule released on extrapolation earlier this year hopefully we can use some of the findings to springboard improvement. Thanks for reading. If you find this…
Read MoreExplosive growth of Medicare Advantage covered lives requires organizational mindset shifts
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…
Read More“Bermuda triangle” of Medicare Advantage scrutiny signals alarm bells: Get your risk adjustment house in order
By Jason Jobes Is healthcare prepared to sustain the onslaught of changes to Medicare Advantage payments? How will it impact the industry? How does it impact you? At the beginning of this month I attended the RISE conference, which serves a community of established and emerging leaders in the Medicare Advantage and managed care space.…
Read MoreAHA critiques Medicare Advantage, makes recommendations regarding sepsis criteria, SDOH, and medical necessity determinations
By Brian Murphy The American Hospital Association’s commentary to CMS on the Medicare Advantage (MA) program CY 2024 proposed rule is a good read … if you are a CDI and coding policy wonk who likes this sort of thing. As I do. Because it offers a candid look into who wields the ultimate power…
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