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Federal agencies are scrutinizing Medicare Advantage coding with inaccurate diagnoses for enrollees with certain high-risk diagnoses.

CINCINNATI, Ohio, Sept. 18, 2023 — Ensemble Health Partners (“Ensemble”), the leading revenue cycle management company for hospitals, health systems and physician practices, has received two of the four 2022 Clarivate Healthcare Business Insights (“HBI”) Revenue Cycle Awards for strong performance on revenue cycle key performance indicators. One partner health system was recognized in the

The OIG’s recommendations primarily focus on state oversight. However, it may be appropriate for additional rulemaking to require states to establish their own guardrails around MCOs. These guardrails would ensure prior authorization decisions align with state Medicaid standards for medical necessity and limit when MCOs may use their own internal coverage criteria to deny beneficiary access to care.

Cincinnati, Ohio, – Sept. 21, 2023 – Ensemble Health Partners (“Ensemble”), the leading revenue cycle management company for hospitals, health systems and physician practices, received the top score for overall performance among end-to-end revenue cycle outsourcing vendors in KLAS Research’s End-to-End Revenue Cycle Outsourcing (“RCO”) 2023 Performance Report.

The stated goal of this bill is to prevent HOPD rates from being paid for services rendered in free-standing physician offices or other settings that should be reimbursed at a lower cost. There is also speculation the bill might be the first step in a larger reimbursement model overhaul aimed at aligning HOPD reimbursement rates with those of ASCs and physician practices.

On April 5, 2023, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that requires Medicare Advantage (MA) plans to follow traditional Medicare laws for coverage decisions, limits the use of prior authorization, mandates continuity of care for Medicare beneficiaries and establishes a Utilization Management (UM) Committee with a heightened standard for adverse medical necessity decisions. 

This is the fifth year in a row that Ensemble and its clients were recognized Cincinnati, Ohio (June 25, 2023) – Ensemble Health Partners, an industry-leading revenue cycle management company, in support of three healthcare provider clients, has been named a recipient of three 2023 MAP Awards for High Performance in Revenue Cycle, sponsored by

This marks the fourth consecutive year that Ensemble’s service has been top-rated for client experience and satisfaction in the annual survey. Cincinnati, Ohio, June 8, 2023 – Ensemble Health Partners (Ensemble) has been named the top ranked End-to-End RCM Outsourcing Service for Hospital Chains, Systems, Corporations and Integrated Delivery Networks, as well as the best End-to-End RCM

The recent decision by Cigna to administratively deny claims lacking corresponding CPT/HCPCS codes for revenue codes 270-279 is not expected to have a significant impact on revenue. However, this change does raise some administrative concerns, particularly for providers operating under percent-of-charge payment agreements with Cigna.

In summary, this new rule introduces several key changes that will promote transparency and consistency in healthcare coverage decisions for MA beneficiaries, while ensuring healthcare providers are able to provide the best possible care to their patients.