Brian Wroblewski

Major Changes Coming For The KC Market 📢 Blue KC to Exit Medicare Advantage Market by 2025 Due to Regulatory Demands 📢 Blue Cross and Blue Shield of Kansas City (Blue KC) has announced its departure from the Medicare Advantage (MA) market by the end of 2024, citing increased regulatory demands and financial pressures as primary reasons for the decision. The company will shift its focus to employer-sponsored health plans, Medicare supplement plans, and Affordable Care Act plans while ensuring uninterrupted, quality service to current MA members through 2024. With a smaller MA membership base, Blue KC finds it challenging to compete economically at scale, leading to the difficult but necessary market exit. In a statement, Blue KC's President and CEO, Erin Stucky, expressed disappointment, saying, “We explored every alternative path for our MA members and are disappointed we must exit this line of business.” This move aligns with industry trends, as other insurers, like Oscar Health, have also exited the MA market due to similar challenges, including the impact of regulatory changes such as the CMS's benchmark payment adjustments on the profitability of MA plans for smaller insurers. #Healthcare #MedicareAdvantage #BlueKC #RegulatoryChallenges #InsuranceIndustry #HealthPlans #CMS #MarketExit

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Medicare Advantage unrest, Change Healthcare fallout and more big takeaways from insurers’ Q1 https://lnkd.in/eyg48k7e via Healthcare Dive #MedicareAdvantage #ChangeHealthcare #Cybersecurity #CMS #Medicaid

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Off-Cycle SNF Provider Revalidation: Mandatory Form CMS-855A Top 7 Things To Know: 1. Mandatory Revalidation: Starting October 1, 2024, all SNFs must revalidate their Medicare enrollment by the end of the year. This process requires completing an updated CMS provider enrollment form, which now asks for more detailed information than before. 2. Off-Cycle Revalidation: Normally, provider revalidation happens on a regular cycle. However, this "off-cycle" revalidation is a one-time requirement starting this year, impacting 100% of SNFs, regardless of their size or ownership structure. 3. CMS Enrollment Form 855A: The new form, which must be completed by SNFs, is longer (20 pages compared to the previous 14 pages) and includes additional sections about "Additional Disclosable Parties" (ADP). SNFs must provide detailed information about all ADPs that have a significant operational or financial role in the facility. Providers can access the form via the PECOS (Provider Enrollment, Chain, and Ownership System) online platform. ·     Visit the PECOS website: https://lnkd.in/g5kBTqfW ·     Log in using your CMS credentials. ·     Locate the revalidation section. ·     Link to CMS 855A Form: chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://lnkd.in/gqAvEnZk 4.    Timeline: ·     CMS will send letters to SNFs starting on October 1, 2024, and through the end of the year. ·     Providers have 90 days to respond after receiving the letter. ·     Failure to complete the revalidation in time could disrupt the facility's ability to bill Medicare.   5.    Additional Disclosable Parties (ADP): This is a key new requirement. An ADP is anyone or any entity that: ·     Has significant operational, financial, or managerial control over the SNF. ·     Owns, leases, or subleases property to the SNF. ·     Provides management, consulting, or financial services to the SNF. This information must be disclosed in the new enrollment form. 6. Importance of Compliance: SNFs must complete this revalidation within the specified timeframe to avoid disruptions in their Medicare billing. Providers are advised to consult legal counsel to ensure they correctly interpret the reporting requirements and avoid errors in their submissions. 7. PECOS System: The information must be submitted through the PECOS system, which is the online system used by CMS for provider enrollment. This process requires more detailed reporting, especially concerning the ownership and operational control of SNFs and the ADPs involved with the facility. Since all SNFs are affected, every provider should be prepared for this and take timely action to prevent any interruption in Medicare billing. Failure to comply could result in significant financial issues for the facility. #SNFCompliance #MedicareRevalidation #CMSUpdates #HealthcareProviders #HealthcareCompliance #CMSFrom855A

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Interesting trends in the insurance industry

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RCM insight ✴️ Healthcare organizations can analyze payer performance, reimbursement rates, and historical contract terms to negotiate more favorable agreements with insurance companies. SAHEH_صحيح #insurance #claim #healthcare #rcm #providers #revenuecyclemanagemnt

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Condensed summary of the 1300+ page 2025 #CMS rules for #MedicareAdvantage #HealthPlans issued on April 1. Rules cover the 34 million Americans receiving #healthcare through MA financing. The updated MA #compliance officer bible & more important if incremental #healthcarereform via federal rule-making. #PrimaryCare #HealthcareTransformation #SDoH #HealthcareQuality #HealthEquity #PublicPrivatePartnership #PublicPrivatePartnerships

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#CMS will require states and #Medicaid insurers to annually report how carriers spend state-directed payments to #providers, how their rates compare to #Medicare, and survey #ManagedCare enrollees about their experience with insurance companies. CMS also mandated states create “one-stop-shop” websites that allow enrollees to compare the quality ratings of #MedicaidManagedCare plans. Hmm. Medicaid continues to look more and more like #MedicareAdvantage with each new set of federal rules: more ongoing #HealthcareReform on the margins via national rule-making. #HealthcareTransformation #TripleAim #QuadrupleAim #PrimaryCare #SDOH #PopultionHealth #PublicPrivatePartnership #PublicPrivatePartnerships #DSNP #DualEligible #BehavioralHealth #MentalHealth #HealthEquity #FoodisMedicine #HealthcareQuality #HealthcareCosts #HHS

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Automation transformed ARH’s revenue cycle, saving 1,000+ hours and recovering $2M+ in denied claims in 2 months. Partnering with LBMC and EnterBridge, ARH has increased revenue and empowered its team to focus on strategic tasks. Learn how this innovation can benefit your healthcare facility. #HealthcareAutomation #RevenueGrowth #LBMC

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Accelerating MMIS Implementation with Newgen Software: GHIT Digital POV The Medicaid Management Information System (MMIS) is a vital platform that automates and manages the Medicaid program lifecycle. It ensures smooth administration of Medicaid services, from claims processing and beneficiary eligibility to provider management and compliance reporting. MMIS integrates business workflows with advanced technology to improve operational efficiency, maintain compliance with Centers for Medicare & Medicaid Services (CMS) regulations, and deliver better outcomes for Medicaid beneficiaries. Challenges in MMIS Implementation - While the vision for MMIS is clear, execution faces hurdles: - Complex Business Rules: Customization for state-specific Medicaid programs. - Regulatory Overload: Adapting to evolving CMS requirements and audits. - Legacy System Integration: Ensuring interoperability with outdated platforms. - Scalability: Managing the increasing volume of claims and beneficiaries. GHIT Digital, in partnership with Newgen Software, addresses these challenges with the NewgenOne Platform. This AI-powered, Low-Code, and Modular platform is perfectly aligned with the modern MMIS architecture and provides the tools necessary for efficient implementation and long-term success. Call to Action For Medicaid agencies, Managed Care Organizations (MCOs), and other stakeholders, GHIT Digital and Newgen Software offer the expertise and technology to revolutionize MMIS implementation. Connect with Monika Vashishtha, President of GHIT Digital, to schedule a personalized demo of the NewgenOne Platform and see how it can transform your MMIS deployment. MonMass, Inc. (the legal name of GHIT Digital) will work on your strategic IT Projects or Consulting requirements (NAICS codes 541511 / 541512 / 541330 / 541618). Feel free to call at 646.734.6482 or write to me at [email protected] for no obligation discovery conversation. You are welcome to share your RFPs/RPQs for us to review and respond on time. Click the Pic below to read the rest of the POV.. https://lnkd.in/eniSWN-e

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The Czar is speaking TOMOROW on the new 2025 Medicare rules from Centers for Medicare & Medicaid Services!!! pretty much the biggest legal webinar in the Medicare vertical ever... still free. for now. Puja J. Amin Christopher Deatherage John Henson #tcpa #cms #aep #oe #Medicare #advantage #leadgen #tpmo #ptc #pewc #2025 #webinar #learn #deservetowin

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In 2023 Medicare Advantage was enjoying a long and profitable growth streak, with plans expanding geographically into previously under or unserved areas. With the CMS changes to 'risk adjusting', 2024 became a difficult year. Now in 2025, plans are generally retreating from unprofitable markets, limiting product offerings, and cutting generous benefits for things that Medicare does not cover. It seems that health systems have had enough. As Medicare Advantage plans scrambled to maintain profitability, the administrative burden on providers increased and health systems are saying - enough and exiting participation.

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Our specialized team delivers precise medical cost projections, aiding attorneys in estimating future medical expenses for non-catastrophic injury cases. Through our medical expertise and thorough research, we offer reliable projections to support attorneys in formulating effective demands, preparing for mediation, and negotiating fair settlements for their clients. #MedicalCostProjection #HealthcareCosts #Efficiency #PersonalInjury #Attorneys

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🚀 Streamline your billing with smart systems. 💡 Partner with experts for better insurance credentialing. 📈 Use data-driven strategies for growth. Our twist: 📊 We revamp your billing for max efficiency. 🤝 We handle the paperwork, you focus on care. 🌱 We plant growth strategies in your practice. Need a hand? Email us for support! Link: www.mpmastery.com #HealthcareConsulting #MedicalBilling #PracticeGrowth #medicalbilling #credentialing #adminsupport #healthcareconsulting #practicestartup

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Step 6: Simplifying Insurance Processes. Our expert coaches handle all dealings with insurance companies, from credentialing to negotiating fees, ensuring you get the best possible fees. Optimize your insurance processes with expert help. Click here or click the link in bio to get started. #InsuranceSimplified #DentalPracticeManagement #ASDA #NewDentist #DentalCoachUSA

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NEW BLOG POST: "The Latest on Applying Medical Loss Ratio to Dental Insurance: What We Can Learn from NCOIL, CHBRP, and the Trend Across States," by Michael Adelberg, NADP Executive Director. On April 14, the National Conference of Insurance Legislators (NCOIL) formally ratified a model law that allows states and dental plans to ease into a medical loss ratio based on appropriate, pre-existing dental insurance practices in that state. Consecutive-year outlier plans would be subject to corrective actions. With only a couple of tweaks, this model law is based on a 2023 Colorado law, which was based on a 2022 Maine law. Read more: https://ow.ly/i7CH50Rik9y #DentalInsurance #MedicalLossRatio #NCOIL #CHBRP #InsuranceLegislation #HealthcarePolicy #DentalPlans #HealthcareTrends #InsuranceRegulation

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#CMS touts #MedicareAdvantage premium stability, #HealthPlan choice (typically most people have 34 plans to choose from), excellent monitored #provider network adequacy, aggressive #marketing oversight (1000 TV ads rejected) & #PartD copay improvements on a conference call. Expects total 2025 MA enrollment to exceed 35 million. #HealthcareReform #HealthcareTransformation #HealthEquity #PrimaryCare #HealthcareCosts #HealthcareQuality #PatientCenteredCare #PublicPrivatePartnership #PublicPrivatePartnerships

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Ever thought about the real value of health Insurance? With only 12 days left to secure health insurance on the Marketplace that begins on January 1, the time is now to secure or update your health insurance. Not only can health coverage help keep you healthy, it can protect you from the financial stress that can come with it. Your South Florida Blue team works and lives in this region. We know South Florida and bring value to our members every day. And with $0 plans available in Miami-Dade, Broward and Palm Beach Counties, we have the right plan for you and your family. Al Molina, Cindy Mason, Juan Awad, MHSA, Ivy Patron, MBA Read more about the value of health insurance here. https://lnkd.in/giD2wQdh

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