CMS is accepting comments until March 13 on its proposed rule to improve interoperability between payers and providers and eliminate barriers in the prior authorization process that put undue burden on providers and potentially put patients at risk.
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The higher the level of engagement, the more willing your employees are to deliver an outstanding experience to your patients. Engaged employees who are happy and interested in their roles will be much more invested in exceeding expectations of their leaders and your patients, friendlier when dealing with patients face-to-face or over the phone and more productive in their day-to-day responsibilities.
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Even the singular step of creating and effectively overseeing an EAG is likely to have a significantly positive impact on employee engagement, morale and overall company culture.
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Historically, market share has dictated authority during contract negotiations between payors and providers, often giving payors the upper hand. So how can providers of any size level the playing field? They must know what provisions to include in their contracts, leverage comparative data to change payor behavior and use price transparency rules to their advantage.
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A cardiac monitoring company and its subsidiary agreed to a $44.9 million settlement with the Department of Justice (DOJ) following allegations they violated the False Claims Act (FCA) by billing federal programs for heart monitoring services that were knowingly performed outside the US. by unqualified technicians.
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The Biden Administration announced Jan. 30 that the COVID-19 public health emergency (PHE) declaration will end on May 11 with the goal of preventing an abrupt end and allowing more than 90 days for healthcare providers to adjust to the operational and financial implications.
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Ensemble Health Partners (Ensemble), an industry-leading revenue cycle management company, announced it has been recognized as a top workplace in the country by two national organizations.
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As hospitals continue to face unprecedented levels of financial pressure, leaving money on the table isn’t an option. Yet too many hospitals continue to lose anywhere from 1% to 10% of net revenue on underpaid claims each year – money they are contractually owed.
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CMS recently issued a proposed rule that, among several other revisions, could change utilization management and prior authorization criteria for Medicare Advantage (MA) plans as well as amend the definition of an identified overpayment – both of which could impact providers.
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OIG recommended to the Centers for Medicare & Medicaid Services (CMS) that it consider issuing instructions or guidance to the Medicare Administrative Contractors (MACs) that would require or encourage the MACs to more regularly review Medicare bad debts claimed on cost reports.
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