Chad Schmidt

Enhancing Clinical Documentation Integrity: An Essential Mandate for Healthcare Facilities. Optimize patient care, revenue, and compliance through CDI best practices. Explore DocuComp LLC's tailored CDI training and services to elevate your organization's documentation integrity. https://docucompllc.com

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The growth of the health insurance marketplace is picking up steam, fuelled by Medicaid disenrollment. https://ow.ly/N1vW50Tafsq MMIT’s Erin Trompeter explains what these large-scale changes mean for providers, manufacturers, payers and health IT vendors. Get the insights by clicking the link in this post. #HealthInsuranceMarketplace #HealthInsurance #Medicaid

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Revenue cycle automation plans include autonomous coding and claims management tech, but cost and resource management are major barriers to adoption, KLAS reports. #revenuecycle

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😳Humana faces a significant challenge following the release of preliminary 2025 Medicare Advantage (MA) Star Ratings data from CMS. Only 25% of its MA members are now enrolled in plans rated 4 stars or higher, a steep decline from 94% in 2024. 👉🏻The drop was driven primarily by the performance of contract H5216, which covers nearly half of Humana’s MA members, including over 90% of its Group MA plans, and saw its rating fall from 4.5 to 3.5 stars. 💴This will impact quality bonus payments in 2026. Humana is actively appealing some results and working to improve operating discipline to regain its industry-leading position. 🧘Key initiatives will focus on member engagement, customer experience, and technology enhancements to drive long-term value. Medicare Advantage open enrollment kicks off 10/15 and goes until 12/7. STAR ratings expected to be released to the public around 10/10! 📉Down 22% in premarket! https://lnkd.in/gUTT84tR

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#MedicareAdvantage plans facing margin pressures are turning to tactics that create revenue cycle challenges for providers. Learn about key revenue cycle improvement strategies to help providers manage payor relationships, resolve issues, and reduce denials and payment delays when working with #Medicare plans. Read on: https://bit.ly/4dBJvmA

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Medicare Advantage leaders—don’t let Centers for Medicare & Medicaid Services deadlines catch you off guard. Meeting these dates isn’t just protocol; it’s vital to protecting your reimbursements and minimizing RADV audit risks. Our latest blog breaks it down: ✅ Key deadlines for 2024, 2025 and 2026 ✅ Compliance strategies that simplify submission ✅ Audit prevention tips to keep your team prepared Plus, download our 𝗙𝗥𝗘𝗘 𝗖𝗠𝗦 𝗦𝘂𝗯𝗺𝗶𝘀𝘀𝗶𝗼𝗻 𝗖𝗮𝗹𝗲𝗻𝗱𝗮𝗿 𝗣𝗗𝗙 to keep every critical deadline at your team’s fingertips. Stay ahead of compliance. Read the blog, grab the calendar, and secure your success for 2025 and beyond - https://bit.ly/4fLNUon . . . #CMSDeadlines #MedicareAdvantage #RiskAdjustment

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New Medicare Advantage Quality Ratings Changes are coming! A new calculation will affect how quality ratings are assessed, with the goal for better accuracy and fairness. This of course comes after court findings prompting CMS to take appropriate action. #Medicare #Healthcare #QualityRatings #PayerNews https://shorturl.at/p8y3n

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🏛️💼 Anticipating 2025: Medicare is poised for significant transformations, especially concerning Part D prescription plans. With proposed changes aimed at reducing consumer spending on medications, insurance companies are bracing for increased financial responsibilities. This shift comes as the industry grapples with cost containment in the wake of pandemic-driven expenditure rebounds. How will these changes affect the healthcare landscape? Professionals, share your insights on navigating these upcoming challenges. . . . #Medicare2025 #Medicare #Employeebenefits #Medicarecoverage #HRInnovation #HRChallenges #HR #DoctorsChoiceusa #Healthcare

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As reported in our study with Healthcare Financial Management Association (HFMA) earlier this year, health systems continue to drop Medicare Advantage plans. For the full report: https://lnkd.in/e7q7bxN For a list of health systems dropping MA plans this year: https://lnkd.in/ggvZyEMQ

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The recent announcement of rate cuts to Medicare Advantage plans has significant implications for the earnings outlooks of top national health insurers. This analysis delves into the potential impact of these rate cuts, considering various factors including market reactions, strategic adaptations by insurers, and long-term effects on profitability. Medicare Advantage (MA) plans are a substantial source of revenue for major health insurers. Rate cuts directly reduce the per-member reimbursement these insurers receive from the government. For insurers like Humana, UnitedHealth Group, and others who have considerable proportions of their portfolios in MA plans, this translates into immediate revenue shortfalls. Analyst estimates suggest potential single-digit percentage declines in revenues directly attributable to these rate cuts. The announcement of rate cuts typically leads to negative reactions in the stock market as investors adjust their expectations for future earnings. Insurers with heavy exposure to Medicare Advantage might see more pronounced declines in their stock prices, reflecting investor concerns over reduced profitability. In response to the rate cuts, insurers are likely to intensify their efforts to manage operational costs. This could include more stringent negotiations with healthcare providers, increased adoption of telehealth services to reduce costs, and enhanced focus on preventive care programs to manage or reduce high-cost medical interventions. Insurers might also revise their MA plan offerings by adjusting benefits, premiums, or co-pays to manage profitability margins. Such changes could impact the attractiveness of plans to potential customers, influencing market competitiveness and consumer choice. Over the long term, rate cuts could reshape the competitive landscape of the Medicare Advantage market. Insurers with more diversified portfolios might withstand the impact better than those heavily reliant on MA revenues. New entrants or smaller players might find it challenging to compete effectively, potentially leading to market consolidation. For consumers, changes to plan structures could affect the quality of care and the out-of-pocket costs for beneficiaries. This could influence satisfaction and retention rates, affecting the market shares of various insurers. The need to maintain profitability might push insurers to innovate, particularly in areas like healthcare delivery and administrative efficiency. Investments in technology and data analytics could become even more crucial, enabling insurers to deliver quality care more cost-effectively. While the rate cuts pose immediate challenges to earnings for top health insurers, they also serve as a catalyst for strategic reevaluation and innovation. Insurers' abilities to adapt through cost management, efficient service delivery, and customer-centric plan adjustments will be key determinants of their financial performance in a post-rate-cut environment.

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This is the “Stars For Dummies” piece you’ve been looking for. When some brokers say all plans are the same, on the surface, I can see why - benefit grids are boringly similar. But that’s where the comparisons take a dramatic shift. Quality of care is the key differentiator, and where higher-rated plans do their best work. How can lower rated plans have “richer” benefits than those rated higher (SCAN 4.5 Stars!)? Because we are here when actual healthcare is the patient’s (and broker’s) priority. We approve your referrals, pay claims, and work with our members to stay healthy and independent. Broker question - If your parents were looking for a health plan, do Stars influence your selling decision? Assuming your truthful answer is yes, then why do you sell the others? If higher quarterly grocery benefits is the answer, there are lots of things you should reconsider.

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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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Risk adjustment continues to grow more complex, especially for Medicare Advantage plans. Our recent RISE webinar shared best practices to improve coding quality and fresh ideas for building a successful digital data strategy. Watch it on-demand for insights on: ▫️ Improving risk adjustment coding accuracy ▫️ Meeting providers where they are ▫️ Advancing interoperability to drive impact https://bit.ly/49HsK7m #Medicare #RiskAdjustment #interoperability

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CMS’s 2025 Medicare Advantage star ratings are down—only 62% of enrollees are in 4-star+ plans vs. 90% in 2022. Are plans getting worse—or is CMS stricter? Joe Albanese explains the new CMS rules and their impact in this week's #ParagonPIC. READ: https://t.co/1c6vwrlEiB MA star ratings peaked in 2022 but have fallen since. #MedicareAdvantage’s average star rating fell to 3.92 for 2025, with just 7 plans earning 5 stars. Avoiding "grade inflation" for stars may be one goal, but the ratings have other well-known flaws. Plans want to get more stars and earn bonuses, but this encourages a focus on government metrics rather than accountability to enrollees. And the cost of bonuses has risen over the past decade. #MedicareAdvantage #StarRatings Technical changes to CMS calculations are likely a bigger factor in declining stars than worsening plan quality. But fixes to the star ratings and quality bonuses are needed.

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Stop by the Veradigm booth at RISE RIsk Adjustment Forum to experience firsthand how we're transforming risk adjustment! 🎉Veradigm Payer Insights is a dynamic solution to help #payers address care gaps by delivering alerts directly to providers via their existing #EHR workflow. #RiskAdjustment

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For CDI, promptness and accuracy are crucial for claims filing. Learn how El Paso Children's Hospital boosted CDI productivity by 50%, achieving a 95% increase in physician agreement rate. https://hubs.la/Q02wTyC70

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