Jennifer Blomquist

🔍 Exploring MultiPlan's Healthcare Billing Practices: A Critical Analysis 🔍 In a recent investigation, concerns have been raised about MultiPlan's billing practices within the healthcare industry. MultiPlan, known for its preferred provider organization (PPO) network product and related services, has come under scrutiny for potentially violating the No Surprises Act. MultiPlan's PPO product offers health plans the flexibility to utilize their networks as primary or complementary options. However, recent revelations suggest that clients may bypass agreed-upon rates, leaving providers and patients in the dark until after services are rendered. The No Surprises Act, implemented earlier this year, aims to protect patients from unexpected medical bills by requiring providers and health plans to disclose specific cost breakdowns before services are provided. This raises questions about MultiPlan's practices and whether they comply with these regulations. While MultiPlan has issued statements defending its mission of affordability and fairness, questions linger about the extent of their responsibility and transparency in decision-making. Expert analysis from Jack Hoadley of Georgetown University's McCourt School of Public Policy sheds light on how the No Surprises Act addresses these issues, particularly through advance explanation of benefits (AEOBs) to provide patients with financial transparency before services are rendered. As discussions around healthcare billing transparency continue, it's crucial for stakeholders to understand the implications of these practices on patients, providers, and insurers alike. Read more about the investigation and expert insights in the full article. Let's ensure transparency and fairness in healthcare billing practices for the benefit of all involved. #HealthcareBilling #Transparency #NoSurprisesAct

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**CMS 2025 Final Rule & Key Implications** -Payment Rates: A 2.93% reduction for 2025 (conversion factor: $32.25). Your focus on efficient care delivery and accurate coding is essential to offset reductions. -KX Modifier: Therapy thresholds increased to $2,410 for PT/SLP and $3,000 for OT, making documentation critical to avoiding denials. -Telehealth Adjustments: Congress may determine whether current flexibilities continue. New allowances include audio-only telehealth and expanded billing for caregiver training services (CTS). -Therapy Assistant Supervision: General supervision replaces direct supervision in outpatient settings, offering greater flexibility and improving access to care. -Therapy Plan Certification: Physician orders can now act as signatures, reducing delays in therapy initiation and administrative burdens. Check out the HealthPRO Heritage comprehensive overview of the latest changes and their potential impact on your organization by reading our detailed summary of the Final Rule updates. #CMSFinalRuleUpdates

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Whether you're a small homecare agency with a handful of clients or a large provider with thousands, HHAeXchange offers tools to help you better manage your business. Check out this guide to see how agencies at every stage can utilize the HHAeXchange platform:

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🔍Is your behavioral health treatment strategy reactive or proactive? Starting May 7th, providers and patients can proactively measure treatment and gain insights into symptom severity with our new Behavioral Vital Signs™ report. As a provider, you'll get a comprehensive PDF report via secure message or right in your EHR. This includes trends for clinically validated surveys, actionable self-report data, and even intelligent passive sensing insights for the last 30 days. As a patient you will receive the same report in the Health Rhythms app, where you can share it with your wider care team and securely review them month over month. It's time to improve our mental health measurement capabilities to enhance treatment strategies and improve outcomes. #DigitalHealth #MentalHealthCare #HealthcareInnovation #PatientCare #healthrhythms #bvs #behavioralvitalsigns

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🚨 Coming Soon: How healthcare payers can navigate CMS-0057 & TEFCA 🚨 Are you ready for the upcoming FHIR API mandates? Our latest article breaks down what healthcare payers need to know about CMS-0057, TEFCA, and the critical deadlines ahead. Don’t get caught in the 2025 implementation crunch—learn how to leverage this digital transformation for a strategic advantage. Stay tuned!

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Join UnisLink tomorrow for an #AskMeAnything webinar and get all your billing questions answered! #Webinar #LiveEvent #Healthcare #AMA #RevenueCycle

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A lot of new payment models rolling out recently from TEAM to ACO FLEX. So not surprised the last two months in talking to VBC leaders on the road the conversations have been geared towards trying to expand on current efforts that have made them successful in current models. One of the largest takeaways, was the misconception that digital engagement tools don't properly fit into current efforts to succeed in VBC agreements. The conversations and appetitie to introduce digital tools, especially engagement solutions was very large. So Sonni Mun, M.D. and I went to task to talk to leaders specifically in MSSP ACOs- where they see digital engagement tools fitting to what already works within a MSSP ACO. They saw five areas where digital engagement tools can expand on current efforts that have made MSSP ACOs successful: - Accurately Capturing Member Risk - Promoting Preventive Care Services - Continual Growth to Properly Manage Care Transitions - Monitoring Chronic Conditions - Ensuring Interoperability Looking forward to seeing more discussion on the new models and the proper alignment with technology. Check out our findings below #vbc #mssp #acos #digitalhealth

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🔄 31 Health System Revenue Cycle Leadership Moves! 🔄 Big changes in revenue cycle management—what’s behind the leadership shakeup, and how will it impact financial performance? 🏥💼 https://lnkd.in/gprfHNEu #RevenueCycle #HealthcareLeadership #RCM

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Great article by Priti Choksey Shah on the importance of integrating Clinical Documentation Integrity (CDI) and Utilization Management (UM) in hospitals. #HealthcareInnovation #RevenueManagement #AIinHealthcare #HospitalEfficiency #CDI #UM

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NEWS ALERT- CMS has finally released the 2023 MSSP results. The results provide tremendous insight on the ACO landscape, risk adjustment, and value based care. Here are some numbers: Thanks for reading. Help us get the word out by smashing the like button, sharing the post, or commenting. Key stats -453 ACOs with data released -69% of ACOs achieved shared savings -$3.08 billion dollars in shared savings payments to organizations -The top 10 organizations with the most savings racked up $631M, or 20% of all savings. -Average risk score for the top 10 organizations with the largest savings in pure dollars (not adjusted for ACO size) was 1.137 -Average risk score for the top 10 organizations with the largest savings per beneficiary was 1.379 -75% of organizations with a risk score above 1.00 had shared savings. Only 65% of organizations with a risk score below 1.00 had shared savings. -78% of the largest 100 ACOs by size had savings while only 64% of the 100 smallest ACOs had savings. CMS noted "ACOs led by primary care clinicians had significantly higher net per capita savings than ACOs with a smaller proportion of primary care clinicians. These results continue to underscore how important primary care is to the success of the Shared Savings Program." This makes sense because primary care is such a critical driver in overall patient care success and in accurately reflecting risk scores. There is a LOT more to dig into. My main takeaways are: 1) Primary care participation is a driver of success 2) Risk scores are a critical component of success and organizations in risk should have outpatient CDI programs and strong compliance programs 3) Larger organizations may have more resources and infrastructure to build scale for success Let's talk more about this. What do you see in the data? What is your experience with your ACO? https://lnkd.in/erjc-peV

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Time for quarterly earnings season: - Elevance Health (Anthem) - reports increased revenue despite loss in membership due to the increased PBM revenue from CarelonRx. - CVS Health - "PBM profits continue to outperform driven by Cordavis contribution and Specialty growth" - Cigna Healthcare - Quarter over quarter PBM membership was down and yet - 2Q Express Scripts by Evernorth profit was up 7% driven by 3% growth in the PBM - UnitedHealth - "In the first half of the year, revenues grew by nearly $14 billion with strong contributions from across the enterprise, led by double-digit growth in Optum" Employers these companies thank you for your continued support in helping them drive record profits. Elevance Health is particularly excited and bullish on the opportunity ahead of them to force employers to use CarelonRx. I recently heard that they have an internal terminology used by the underwriting team when clients ask for pass-through PBM pricing. They call it "tinted glass" and have various models or levels they provide based on how smart the client is and how hard they are pushing. Dealing with these companies is like going to Vegas. The house always wins. While legacy PBMs continue to extract money from employers across the country SmithRx continues to focus on saving money for our clients. You dont have to trust us. You can ask our clients or look at our google reviews (since every other PBM hides those too). #pharmacybenefits #employeebenefits #PBM Rich Hejny Taylor Rogers

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Get the inside scoop on optimizing EHR investments with insights from Christina Berg. Learn how streamlined workflows can significantly enhance both clinician satisfaction and IT efficiency. Let’s push healthcare towards better functionality and care! 🩺🌐 For more insights and discussion, check out the full story: https://ow.ly/X4fs30sC25g #ImprivataEmpowers #EHRsuccess

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📢 Optimize Your Workforce with EVV Scheduling Software Are you looking to streamline your operations and empower your team to deliver better care? This blog explores how EVV (Electronic Visit Verification) scheduling software can revolutionize workforce management by improving efficiency, reducing errors, and ensuring compliance. Authored by Vijay Pandey, this post provides actionable insights to help home care organizations overcome workforce challenges and embrace technology-driven solutions for better care delivery. Visit: https://lnkd.in/g7yQw2KC Let’s shape the future of care, together! 🚀 #HomeCare #EVVSoftware #WorkforceOptimization #CareManagement

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EHR Innovation: Streamlining Payments for Capitated Providers and Large Networks In the ever-evolving landscape of healthcare reimbursement, Electronic Health Record (EHR) systems are stepping up to address a critical need: streamlining electronic payment delivery and reconciliation for capitated providers. This innovation is particularly crucial for providers managing payments to large external networks. Let's break down the key efforts and their impact on the healthcare ecosystem. The Challenge Capitated providers face a unique set of challenges: 1. Managing diverse payment preferences across large provider networks 2. Ensuring timely and accurate payments 3. Reconciling payments with services rendered 4. Maintaining compliance with various regulatory requirements EHR Solutions: Breaking It Down 1. Integration of Payment Platforms Epic Systems: - Introduced Epic Payments, a comprehensive solution that integrates directly with their EHR. - Allows for real-time payment processing and reconciliation. - Supports multiple payment methods, including ACH, virtual cards, and traditional checks. Cerner: - Partnered with Sphere to offer an integrated payment solution. - Focuses on enhancing revenue cycle management through streamlined payment processes. 2. Automated Preference Management Allscripts: - Developed a provider preference engine that automatically routes payments based on the receiving provider's preferred method. - Utilizes machine learning to continuously optimize payment routing. 3. Blockchain for Transparency Meditech: - Experimenting with blockchain technology to enhance transparency in the payment process. - Aims to create an immutable ledger of transactions, reducing disputes and improving trust. 4. AI-Driven Reconciliation athenahealth: - Implemented AI algorithms to automate the reconciliation process. - Matches payments with claims and encounters, significantly reducing manual work. 5. Compliance and Reporting eClinicalWorks: - Focused on building robust reporting tools that ensure compliance with various value-based care models. - Provides real-time analytics on payment performance and network utilization. Continued…

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The time is now for new business models for virtual care to integrate more fully with existing care or to focus on unmet needs like chronic condition management….

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Too often, siloed healthcare software and data leads to patient safety challenges. RLDatix CEO Jeff Surges and Nashville General Hospital Chief Revenue Officer Kemberly Blackledge, DSc, FACHE discuss these systemic problems and the impact that connected healthcare operations has on patient safety in a new American College of Healthcare Executives blog post, "Driving Safer Care With Better Margins Through Connected Healthcare Operations." Check out the piece here: https://lnkd.in/dFBaxhGk. #Healthcare #ConnectedHealthcare #RLDatix"

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Still time to register for this webinar. How Technology-enabled CDI improves Financial Health and Clinical Outcomes.

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If you're ready to take the next step towards optimizing your healthcare workforce, consider reaching out to AMN Healthcare for a consultation. Their proven technologies and strategic insights could be the key to unlocking your organization's full potential. #AMNHealthcare #WorkforceSolutions

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APPs remain critical features of the medical practice redesign. Is your organization positioned to ensure APPs practice at the top of their license? If not, we should connect! #advancedpracticeproviders #NP #PA #CRNA #chghealthcare

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