Medicare Advantage UpCoding Has Been Eliminated by CMS Effective 2022
By GEORGE HALVORSON Medicare Advantage now enrolls almost exactly half the people enrolled in Medicare — and has both significant fans and hardline opponents in the health care policy circles who disagree about its performance. The biggest attack point that comes from the critics deals with the issues of coding accuracy by the plans. The payment model for the program is capitation — and that capitation is based on the average cost of fee-for-service Medicare in every county. The people who designed the model believed that the country should use the average cost of fee-for-service Medicare in every county as the b...
Source: The Health Care Blog - January 23, 2023 Category: Consumer Health News Authors: matthew holt Tags: Health Policy CMS George Halvorson Medicare Advantage Source Type: blogs

Costco Wholesale: What Is Its Pharmacy Strategy? It's Complicated.
Conclusion: Costco Pharmacy Manages Hybrid Cash/Insurance Payments for Rx Drugs Better Than Most Other Big Pharmacy Chains. Still, Costco Won ' tALWAYS Be the Low-Price Leader Because of How the U.S. Prescription Drug Market Functions.Costco Pharmacy ' s cash prices for many prescriptions may be low enough for people to simply bypass their insurance and pay out-of-pocket, which Costco welcomes, similar to how Mark Cuban Cost Plus Drug Co. or a number of other rapidly-growing, cash-only pharmacies which are popping up nationwide operate because their cash prices may be potentially even cheaper than by using insurance. Howev...
Source: Scott's Web Log - January 21, 2023 Category: Endocrinology Tags: 2023 Big pharma bypass insurance cash pharmacy cash-only pharmacy Costco Costco Wholesale Corp. PBM ' Source Type: blogs

Congressional Pay for Performance: No Budget, No Pay
Romina BocciaImagine you are an executive at a major corporation. One of the core responsibilities of your job is to collaborate with the other executives to adopt budget and organizational policies for your corporation each year. Instead of meeting your responsibilities, most years the corporation is forced to operate without a budget as outdated policies continue and the firm bleeds red ink. Such a dysfunctional corporation likely wouldn ’t last very long. You and the other executives would also likely face pay cuts, before eventually getting fired.Now, imagine this same scenario, but you ’re a me...
Source: Cato-at-liberty - January 17, 2023 Category: American Health Authors: Romina Boccia Source Type: blogs

Activating Transparency in Health Care Pricing
The Centers for Medicare & Medicaid Services (CMS) have taken up the campaign for price transparency over the past few years. The need for this is obvious and pressing. Unlike any other industry, health care institutions have historically been totally free to charge what they want and not even tell you in advance. Most of us have had lived the horror movie that follows a hospital stay, receiving a bill in the mail…and then another bill…and another… Hospitals have trouble predicting how much a procedure will cost for many reasons. They have a welter of agreements with different insurance companies and ...
Source: EMR and HIPAA - January 13, 2023 Category: Information Technology Authors: Andy Oram Tags: Administration Analytics/Big Data Health IT Company Healthcare IT Revenue Cycle Management CMS Costs Healthcare Cost Transparency Healthcare Price Transparency Healthcare Prices Healthcare Pricing Marcus Dorstel Turquoise Health Source Type: blogs

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CMS’ new Medicaid waiver policies enable states to pursue new investments, including those addressing health disparities and focused on underserved populations.        (Source: The Commonwealth Fund: Blog)
Source: The Commonwealth Fund: Blog - January 11, 2023 Category: International Medicine & Public Health Authors: Cindy Mann, Mindy Lipson Source Type: blogs

Health Equity and SDoH – 2023 Health IT Predictions
As we head into 2023, we wanted to kick off the new year with a series of 2023 Health IT predictions.  We asked the Healthcare IT Today community to submit their predictions and we received a wide ranging set of responses that we grouped into a number of themes.  Check out our communities predictions below and be sure to add your own thoughts and/or places you disagree with these predictions in the comments and on social media. Check out our community’s health equity and SDoH (Social Determinants of Health) predictions. Ted Quinn, CEO and founder at Activate Care Continued economic instability will put more America...
Source: EMR and HIPAA - January 10, 2023 Category: Information Technology Authors: John Lynn Tags: Health IT Company Healthcare IT 2023 Health IT Predictions Activate Care Adrienne Boissy Carenet Health Chelsea King Arthur Get Well Health Equity Matt Dickson Patient Discovery Qualtrics SDOH Social Determinants of Health Sunw Source Type: blogs

Pharma – 2023 Health IT Predictions
As we head into 2023, we wanted to kick off the new year with a series of 2023 Health IT predictions.  We asked the Healthcare IT Today community to submit their predictions and we received a wide ranging set of responses that we grouped into a number of themes.  Check out our communities predictions below and be sure to add your own thoughts and/or places you disagree with these predictions in the comments and on social media. Check out our community’s pharma predictions. Jesse Cugliotta, Global Industry GTM Lead, Healthcare & Life Sciences at Snowflake Industry investments in data platforms to enable decentra...
Source: EMR and HIPAA - January 9, 2023 Category: Information Technology Authors: John Lynn Tags: Health IT Company Healthcare IT 2023 Health IT Predictions Abrpo BrainCheck Doceree Harshit Jain Ian Chen Jesse Cugliotta Kimberly Powell Lance Hill Lauren Ohlsson Mike Montalto NVIDIA Ofer Sharon OncoHost PathAI Pharma Source Type: blogs

Revenue Cycle Management Company RSi Announces Acquisition of Invicta Health Solutions
Decisive move brings Invicta’s Insurance Discovery, Claim Status, Eligibility Verification, Medicaid Enrollment, and Out-of-State Medicaid Billing solutions to the RSi portfolio RSi, LLC, a leading national provider of revenue cycle services for the hospital and large physician practice market, has announced its acquisition of Invicta Health Solutions, LLC (Invicta). Invicta, based in Houston, Texas, has earned a reputation for progressive tech integrations, unique partnerships with established entities, and a mastery of business intelligence to recast traditional revenue cycle management services such as Insuranc...
Source: EMR and HIPAA - January 9, 2023 Category: Information Technology Authors: Healthcare IT News Tags: Health IT Company Healthcare IT Revenue Cycle Management Brent Rollins Derek Shaw Donny Zamora Health IT Acquisitions Healthcare M&A Invicta Health Solutions Jude Crowell Matt Carroll RCM RCM Acquisitions RSi WestView Capital P Source Type: blogs

Bonus Features – January 8, 2023 – Omnibus bill extends telehealth expansion through end of 2024, 60% of solution providers pouring all event marketing money into in-person events, and more
This article will be a weekly roundup of interesting stories, product announcements, new hires, partnerships, research studies, awards, sales, and more. Because there’s so much happening out there in healthcare IT we aren’t able to cover in our full articles, we still want to make sure you’re informed of all the latest news, announcements, and stories happening to help you better do your job. News On Dec. 29, 2022, President Biden signed the omnibus spending bill. The biggest news for healthcare IT was the extension of telehealth expansion under Medicare through the end of 2024. This includes expansion of originating...
Source: EMR and HIPAA - January 8, 2023 Category: Information Technology Authors: Brian Eastwood Tags: Healthcare IT 4medica ADAPT AdvancedMD AHA Ardent Health Services Blendid Brian Berning Cadence Carenet Health Carol DeVol CharmHealth CipherHealth Comcast Healthcare CORL directtrust East Tennessee Health Information Netwo Source Type: blogs

Telehealth and RPM – 2023 Health IT Predictions
As we head into 2023, we wanted to kick off the new year with a series of 2023 Health IT predictions.  We asked the Healthcare IT Today community to submit their predictions and we received a wide ranging set of responses that we grouped into a number of themes.  Check out our communities predictions below and be sure to add your own thoughts and/or places you disagree with these predictions in the comments and on social media. Check out our community’s telehealth and RPM (Remote Patient Monitoring) predictions. Dr. Reza Hosseini Ghomi, Chief Medical Officer at BrainCheck Digitally-enabled care is the future of tel...
Source: EMR and HIPAA - January 6, 2023 Category: Information Technology Authors: John Lynn Tags: Health IT Company Healthcare IT Telemedicine and Remote Monitoring 2023 Health IT Predictions Ankit Gupta Bicycle Health BrainCheck Carlene MacMillan Chris Sullivan Dan Trigub David Feldman Epicore Biosystems MedArrive Medisafe Source Type: blogs

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Millions with private insurance and Medicaid expansion plans could lose access to free preventive services if the Supreme Court upholds a recent ruling.        (Source: The Commonwealth Fund: Blog)
Source: The Commonwealth Fund: Blog - January 6, 2023 Category: International Medicine & Public Health Authors: Celli Horstman, Jesse C. Baumgartner, Arnav Shah Source Type: blogs

Featured Health IT Job: Healthcare Data Analyst
We like to regularly feature a healthcare IT job that might be of interest to readers. Today, we’re featuring the Healthcare Data Analyst position that was recently posted on Healthcare IT Central. This position was posted by New York eHealth Collaborative and is in New York. Here’s a description of the position: New York eHealth Collaborative (NYeC) is a not-for-profit organization working in partnership with the New York State Department of Health to improve healthcare by collaboratively leading, connecting, and integrating health information exchange across the State. Founded in 2006 by healthcare leaders,...
Source: EMR and HIPAA - January 5, 2023 Category: Information Technology Authors: Health IT Jobs Tags: Career and Jobs Healthcare IT Health Data Jobs Health IT Jobs Healthcare Data Analyst Healthcare IT Jobs Job Seekers New York eHealth Collaborative New York Health IT Jobs NYeC Source Type: blogs

SameSky Health is Making Meaningful Progress on Health Equity
Abner Mason is a health equity pioneer. A decade ago, he was already championing more equitable access to care for people with low income and low health literacy. In those early days, it was difficult for Mason to get plans and providers to buy into his vision, but he stuck with it. Now his company, SameSky Health, is helping organizations make meaningful progress addressing health equity gaps. Healthcare IT Today sat down with Mason to get his take on the current state of health equity and to dive deeper into the impact his company is having. Health Equity Defined According to the World Health Organization (WHO), health e...
Source: EMR and HIPAA - January 4, 2023 Category: Information Technology Authors: Colin Hung Tags: Analytics/Big Data C-Suite Leadership Communication and Patient Experience Health IT Company Healthcare IT Abner Mason care equity Health Equity Health Plans Healthcare Bias Hlth HLTH 2022 HLTH22 Medicaid Medicare Advantage S Source Type: blogs

Healthcare Fragmentation Isn ’ t So Bad, If It Comes with Better Outcomes
The following is a guest article by Nate Maslak, Founder & CEO at Ribbon Health. Personalization is embedded into many aspects of our lives, from individualized show recommendations on our Netflix accounts to AI-driven product recommendations based on our shopping habits. And consumers have come to expect and demand this personalization. Recent McKinsey research shows that 71% of consumers expect companies to deliver personalized interactions.  This expectation is expanding into healthcare. Personalized healthcare meets people where they are as an individual with unique behaviors, medical histories and life circumstan...
Source: EMR and HIPAA - January 4, 2023 Category: Information Technology Authors: Guest Author Tags: AI/Machine Learning Analytics/Big Data C-Suite Leadership Communication and Patient Experience Health IT Company Healthcare IT Hospital - Health System Artificial Intelligence Data Fragmentation Data Silos Fragmented Care Healthcare Source Type: blogs

A Change Of Heart: " For The Children "
Last night, I archived everything on the blog except " Why Pediatrics " .  More and more, it ' s become a question rather than a statement of purpose.  In the wake of the COVID 19 pandemic, where the entire US system shifted on its axis to shut down community Pediatrics services and " feed " children ' s hospitals (to free up resources for sick adults), the situation for those of us practicing inpatient Pediatrics (as " Pediatric Hospitalists " ) really went to hell.  You could not find/beg a job in the community setting during the pandemic.  Actually, jumping through the ABP ' s hoops to do a...
Source: Dr.J's HouseCalls - December 24, 2022 Category: American Health Source Type: blogs