Craig Hargenrader

Steward Health files for Bankruptcy and struggling with cash flow, a few interesting points. Hospitals are a business and they need cash flow like patients need blood. Facility leases are one issue, but cash hides a multitude of sins. 1. Steward Health- issues with their REIT Medical Properties Trust 2. Steward shuts down several Texas locations impacting San Antonio patients 3. Steward struggling financially and can't pay vendors...one hospital in Florida was infested with bats 4.Steward leases are a problem, but unpaid patients bills don't help 5.Steward $800 million in losses from 2017 to 2020, pandemic proliferated the issues 6.The patient problem, 2.2 million patients care is now threatened 7.Elizabeth Warren says the issue are the leases...I say try unpaid bill Mrs. Warren, Medical Properties helped LA Cali based Prospect Medical helped them financially. Patients in San Antonio and Massachusetts are seeing the issues first hand. 8.Today it's Steward, tomorrow it could be a Hospital or Physicians Group in <fill in the blank> 9.Maybe the CFPB can help Steward with a lifeline with an interest free loan 10. KG Sarcasm: Not sure Bidenomics can help. Sorry, it must have been POTUS 45 DT issue. Hope Steward can turn the tide and work this out.

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Blue Cross Blue Shield of Texas will terminate its Medicare Advantage and Medicaid contracts with MD Anderson Cancer Center starting November 1. MD Anderson emphasized its intent to ensure continuity of care for patients in active treatment, collaborating with BCBS to support affected individuals. The exact number of impacted patients remains unknown, but BCBS has over 9,200 Medicare Advantage HMO members statewide and manages Medicaid plans in Texas’s Travis and Central regions, including Austin and Waco. Importantly, Medicare Advantage retirees from the The University of Texas System and Texas A&M University systems will not be affected, as MD Anderson will continue accepting certain other Medicare Advantage plans, such as those from Kelsey-Seybold Clinic and BCBS affiliates in Illinois, Montana, New Mexico, and Oklahoma. BCBS Texas, part of Health Care Service Corporation, stated it made this “necessary” decision to optimize care access and cost-effectiveness, promising to assist affected members in finding alternative in-network providers or qualifying them for in-network rates if eligible. The BCBS Texas and MD Anderson split impacts healthcare entities by limiting patient options, disrupting treatment continuity, and increasing administrative burdens as patients seek in-network alternatives. Communities face reduced access to specialized care, especially in critical cancer treatments. Our RCM team assists by coordinating transitions, ensuring accurate billing, and supporting patients and providers in navigating network changes for optimal care continuity. We are the One! #revenuecycle #revenuecyclemanagement #priorauthorization #medicalbilling #medicalcoding #healthcare #healthcaretechnology #accountsreceivables #denialmanagement #consulting #management #implementationpartner Becker's Healthcare

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Medicare fraud is a major issue, costing Americans billions annually. CBS News Texas I-Team exposed a Grand Prairie company linked to over $200 million in fraudulent billings, leading many viewers to share their experiences as victims. Dwight Sandell and Debbie Gollihugh faced fraudulent charges on their Medicare accounts for items they never ordered, like urinary catheters. Similarly, Paula and Winfield Bridge were billed for unordered COVID test kits by multiple Texas companies. Companies like Lone Star Medlab and Peak Health Diagnostics vanished after investigations. The Centers for Medicare & Medicaid Services (CMS) identified 11 companies responsible for nearly $3 billion in fraudulent catheter billing, successfully blocking most funds. Medicare temporarily halted payments for COVID test kits due to fraudulent claims and has implemented safeguards to prevent further fraud. Despite a recent $2.7 billion healthcare fraud crackdown by the U.S. Department of Justice, the Texas companies were not charged. Medicare fraud victims are urged to report issues at 1-800-MEDICARE. Our billing team ensures proper billing practices by meticulously verifying documentation to support clinical services or devices. We conduct thorough audits to confirm accuracy, prevent fraudulent claims, and adhere to compliance standards. This diligence protects patients from incorrect charges and upholds financial integrity, ensuring trust between healthcare providers and patients. We are the One! #revenuecycle #revenuecyclemanagement #priorauthorization #medicalbilling #medicalcoding #healthcare #healthcaretechnology #accountsreceivables #denialmanagement #consulting #management #implementationpartner Microsoft KTVT | CBS DFW

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Cost analysis in isolation lacks depth. Consider comparing costs - or cash shortfalls - from multiple angles: -Procedure codes -CPT codes -Payers -Aged A/R A record of CARCs and RARCs can be used to map shortfalls and denials, getting you closer to the root causes. This is what my team calls an RCM Health Check and I’m covering the concept in a webinar this Thursday. Join me here: https://lnkd.in/epuhRSn7 

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Is keeping financial conversations away from providers a mistake in risk adjustment? 🤔 One common mistake I often see in risk adjustment (RA) is excluding providers from discussions about the financial aspects. Many believe that focusing strictly on documentation rules is the best approach. However, I’ve found that when providers aren’t fully aware of how accurate documentation directly impacts RAF reimbursement, it becomes much harder to engage them in education efforts. Without clarity on the "why," it’s challenging to drive consistent behavior change in their documentation practices. What are your thoughts? Should providers be more involved in the financial side of risk adjustment? Or should the focus remain solely on documentation rules, keeping financials out of the conversation? I’d love to hear your take! 💬 #RiskAdjustment #HealthcareFinance #ProviderEngagement

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UnitedHealthcare and HCA Healthcare resolved a contract dispute just hours before a September 1 deadline, narrowly avoiding a disruption in coverage for members in Texas, New Hampshire, South Carolina, and Denver. The multiyear agreement ensures continued access to 38 HCA hospitals and affiliated locations for UnitedHealthcare’s employer-sponsored commercial plans, Medicare Advantage, and other market-specific plans. The dispute centered on HCA's demands for rate increases, with UnitedHealthcare initially highlighting potential increases as high as 30% over two years in some markets. HCA countered, accusing UnitedHealthcare of proposing below-market rates. HCA, one of the largest healthcare providers in the U.S., with 186 hospitals, generated $65 billion in revenue in 2023. UnitedHealthcare, the nation’s largest private insurer, earned $370 billion in revenue. This resolution comes amid a trend of public contract disputes involving UnitedHealthcare, with other healthcare systems, such as UF Health in Florida, failing to reach agreements. Our credentialing team assists healthcare entities by ensuring that all providers meet compliance standards and are fully credentialed, facilitating smooth negotiations with insurers. This ensures uninterrupted network coverage, mitigates disputes, and supports seamless access to care for patients across various markets. We are the One! #revenuecycle #revenuecyclemanagement #priorauthorization #medicalbilling #medicalcoding #healthcare #healthcaretechnology #accountsreceivables #denialmanagement #consulting #management #implementationpartner Fierce Healthcare

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In our work with health systems and revenue cycle teams, we noticed a gap. Providers don't have an objective tool to measure what "good" looks like when it comes to the patient financial experience. So, we're offering benchmarking free of charge to healthcare providers. Using Cedar's PFX Benchmarks, providers can compare their performance against industry peers and see where they can make meaningful improvements—independent of product utilization and without vendor bias. All in service of redefining "good" through a patient's perspective. Learn more: https://lnkd.in/dgA6bM7J

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The shift of individual health insurance exchange (HIX) models towards the small group commercial market through ICHRA: Individual Coverage HRA presents potential disruption to providers' reimbursement and margins. Payers, having negotiated discounts for HIX products, now target the small group market for growth, leveraging ICHRA plans. Providers face challenges in maintaining fair reimbursement levels as payers seek deep discounts. Providers must strategize around HIX contracting, negotiating for fair rates and preserving commercial margins. They should consider limiting the number of HIX plans they contract with and monitor impacts on yields, such as downcoding and bad debt. Proactive negotiation and strategic planning are essential to avoid compromising long-term financial stability amidst evolving reimbursement dynamics. Providers must assert their position in HIX networks and prepare for potential short-term sacrifices to safeguard long-term commercial margins. Overall, proactive engagement and negotiation are crucial for providers to navigate the evolving landscape of reimbursement in healthcare. Our Revenue Cycle Management (RCM) team can help providers navigate the evolving reimbursement landscape by strategizing around HIX contracting, negotiating fair rates, and optimizing revenue capture. We offer expertise in managing payer relationships and maximizing reimbursements to safeguard long-term financial stability amidst changing reimbursement dynamics. We are the One! #revenuecycle #revenuecyclemanagement #priorauthorization #medicalbilling #medicalcoding #healthcare #healthcaretechnology #accountsreceivables #denialmanagement #consulting #management #implementationpartner Becker's Healthcare

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If you build it, will they come? I’ve heard countless organizations - #MA plans, #Medicaid plans, risk-bearing providers, vendors, PBMs, and retail players - say “we need to build the capabilities to XX”. Many are looking to vendors for solutions, but few vendors are ready to invest in new capabilities without contracts.  Anyone else sensing this (problematic) new conundrum? Here’s my quick take and a few ideas to break through this barrier. Many sales meetings are often held with functional departments, and often do not include the #MedicareAdvantage #StarRatings, #RiskAdjustment, #HEDIS, IT or P&L owners. We must collaborate to get those departments’ urgent needs integrated into new vendor purchases in order for new activities to meet new and emerging needs, remembering that: 🌟 Vendors are vital to your success.  🌟 Vendors operate in a more volatile environment than plans. 🌟 Vendors have smaller budgets than plans. 🌟 Vendors need signed contracts to make significant investments.   🌟 Vague RFPs waste vendors’ time and resources. Collaboration creates win-win contracts which expand capabilities of both parties. I encourage plans to: ✅ Ask vendors about their roadmap; including timing and certainty of planned enhancements. ✅ Include the #Stars, Risk Adjustment and #PartD teams in new vendor discussions. ✅ Consider adding a vendor's roadmap capabilities to contracts. ✅ Co-create with trustworthy vendors. I encourage vendors to: ✔ Ask about the customer’s unmet needs. ✔ Offer to co-create solutions to new and emerging needs with willing customers. ✔ Offer to accelerate roadmap capabilities with willing customers.   ✔ Articulate the things you would be willing to do if a customer would be willing to contract for it. This is a #MarketMakingMoment as #CMS has thrown down the gauntlet with #NewNeedsOfStars and #NewNeedsOfMA. This is a stellar time for vendors to review current and planned capabilities with a broader lens on new and emerging MA, #Compliance, Stars, #ECDS, #Interoperability, #HealthEquity, Medicaid & #SNP Aligment, and Risk Adjustment needs. If you need help, reach out to us.  #WhatGotYouHereWontGetYouThere  ⭐ ⭐ ⭐ ⭐ ⭐

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Why Every CFO in Healthcare Must Understand Medicaid and Medicare Laws In the healthcare industry, the Chief Financial Officer (CFO) plays a critical role in ensuring the financial health and sustainability of an organization. I often refer to this as a delicate balancing act (Some thin Ice). For healthcare CFOs, particularly those overseeing facilities that serve patients on government programs, an in-depth understanding of Medicaid and Medicare laws or otherwise, is not just an advantage but it's a necessity. These laws govern a significant portion of healthcare reimbursements and have a direct impact on an organization’s financial operations. It's also important to note that my background is in banking, where I spent many years before transitioning into healthcare which apparently turns out to be a billion-dollar industry..Some jackpot there!  (a topic for another day). 1. Revenue Management and Compliance Medicaid and Medicare are two of the largest payers in the U.S. healthcare system, providing essential reimbursements to hospitals, clinics, and long-term care facilities. However, the payment structures under these programs are complex, involving various reimbursement rates, coverage rules, and billing codes. A small error in coding or a failure to comply with billing regulations can result in denied claims or, worse, hefty penalties. CFOs must fully understand the intricate laws governing these programs to ensure that billing is accurate, revenue streams remain consistent, and the organization complies with federal and state regulations. 2. Avoiding Penalties and Fraud Allegations Healthcare organizations that accept Medicaid and Medicare funds are subject to strict compliance guidelines. Violations of these laws, even if unintentional, can lead to costly penalties, audits, and even accusations of fraud. This can tarnish the reputation of the organization and lead to significant financial losses. CFOs must have a detailed grasp of these laws to implement strong internal controls, conduct regular audits, and foster a culture of compliance. Understanding these laws also helps CFOs stay ahead of policy changes, mitigate risk and ensure the organization avoids legal entanglements. 3. Strategic Financial Planning Medicaid and Medicare funding can fluctuate due to policy changes, federal budget cuts, or shifts in state allocations. By understanding the laws that govern these programs, CFOs can anticipate how such changes might impact cash flow and financial projections. They can then develop strategies to diversify revenue streams, manage costs effectively, and ensure the organization’s financial sustainability despite potential cuts in government reimbursements. Finally, healthcare CFOs must thoroughly understand Medicaid and Medicare laws to safeguard their organizations against compliance risks, optimize revenue, and plan strategically for the future. This knowledge is crucial for financial stability in an industry. Joseph CFO

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I had a great time sharing insights on senior living investment with 200 investors in Houston this weekend. Interested in getting a copy of my presentation on "The State of Seniors Housing"? Feel free to send me a note. #InvestwithMcFarlinGroup #TotalWealthAcademy

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In this conversation, Joshua Kahr and Howard Altshuler, CPA at Weaver discuss the state of the accounting industry and the Fort Worth real estate market. They explore the growth and opportunities in the Fort Worth area, the impact of the pandemic on the office market, and the strategic growth of accounting firms through acquisitions and private equity investments. The conversation covers various topics related to the accounting profession, including talent acquisition, education requirements, the impact of AI, and the culture of accounting firms. Howard Altshuler shares insights on the challenges and opportunities in the accounting industry, as well as the importance of company culture and talent development.

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CFO's are facing mounting and growing pressure in meeting cash flow targets. In a survey of over 75 CFO’s in the hospital realm, the focus is on rebuilding cash reserves post-pandemic by cutting costs and increasing revenue through service line management. These efforts are often mired in difficulties – from payment vulnerabilities to high denial rates, to underpayments, to resource gaps – and more. So the question really is – what can be done to help position our healthcare systems, something vital to the survival of our country – in a better way, and bypass some of these challenges? In the marketplace, we’ve managed to put together a comprehensive solution package under Healthcare Evolution Group, with help for nearly every issue presented in this article. - PERC’s – with no upfront cost, we create brand new revenue at margins hospital systems can not create themselves. Our services also help with another cost issue – retention and turnover – doctors are fulfilled and happy with the work they get to do, versus the work they have to do. - CareLync – whereas normal current process is cumbersome and leads to only 5% engagement with minimal economic uplift ($100-200/patient/year on 5% engagement) our SaaS software streamlines the intake, sends the right info to CMS, is done as a PPPM, and creates 35-80% engagement with a $3000/patient/year lift. - We partner with a group that helps hospitals recover medical underpayments plus creates an expectation with the carriers to improve the denial rates. - Also, we have bill collection solutions that are far more efficient than the norm, some with an empathetic, compassionate touch. The trend, according to the article is that “81% of survey respondents expecting to integrate AI within three years” - We work with a group that saves hospitals 20-35% on their major medical and ancillary insurance premiums while increasing benefits – meaning better recruiting and retention, as well as major bottom line savings with no disruption upfront. - We help aid in combatting the increasing costs of Rx and behavioral health. - We work with companies that help find cash flow or hidden overpayments or costs that can be reduced after a complimentary audit and examination. Why does this matter? See the comments to understand how all this savings REALLY factors in:

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Appreciate this breakdown on Healthcare Trends in Q4 from an informed source. Agree entirely with how AI is impacting RCM: • Cost Savings: AI reduces the time and manpower required for contract negotiation, claim submission, and payment tracking. • Improved Accuracy: By eliminating manual errors, AI ensures compliance and maximizes reimbursement rates. • Faster Payments: AI expedites claim approvals and denials, improving cash flow for healthcare systems. • Scalability: AI tools allow organizations to handle increased administrative tasks without proportional increases in staff.

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Today I attended the DFW Healthcare Connection networking event sponsored by Grand Brook Memory Care in Grapevine and Catherine Ledbetter of Alpha Omega Hospice. I learned some fascinating tidbits about longevity from William Hatfield of Grand Brook Memory Care. Grip and Leg Strength are good predictors of health and longevity. So, I did some further research because we all hope to stay in our own homes as long as possible. In order to do that, we have to be strong and healthy enough to remain there safely and perform activities of daily living. The Significance of Grip Strength and Leg Strength for Longevity Grip strength is a significant predictor of overall health and longevity. Research indicates that a strong grip is associated with slower biological aging, better overall muscle strength, and a lower risk of chronic diseases and mortality. Here are some key points about the importance of grip strength: 1. Indicator of Overall Health: Grip strength is a reliable indicator of a person's overall body strength, including the ability to fight infections and recover from diseases. It is linked to reduced risk of cardiovascular diseases, stroke, diabetes, and certain types of cancer. 2. Cognitive and Emotional Health: Weak grip strength has been associated with cognitive impairments, such as memory problems and slower processing speeds, as well as emotional health issues like depression. Maintaining a strong grip helps in preserving mental health and reducing the risk of cognitive decline. 3. Physical Independence and Quality of Life: Strong grip strength contributes to better physical independence in older adults, allowing them to perform daily activities and reduce the risk of falls and injuries. This independence is crucial for maintaining a higher quality of life and reducing the risk of frailty. Leg strength is equally important for longevity and overall health. Here are some reasons why maintaining strong legs is vital: 1. Mobility and Balance: Strong leg muscles are essential for mobility and balance, which help prevent falls, a leading cause of injury in older adults. Improved leg strength contributes to better stability and coordination. 2. Functional Independence: Just like grip strength, leg strength supports functional independence by enabling older adults to perform activities like climbing stairs, walking, and standing up from a seated position. This independence is crucial for a higher quality of life. 3. Cardiovascular Health: Engaging in activities that strengthen leg muscles, such as walking, running, and resistance training, also promotes cardiovascular health, reduces the risk of heart diseases, and improves overall physical fitness. Maintaining both grip & leg strength through regular exercise can significantly enhance overall health, reduce the risk of diseases, and improve the quality of life as one ages. My exercise of choice is Pilates & walking. What is yours? Get started now. Your future self will thank you!

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