Krista Riley

With claim denials up 60% in 2024, keeping your practice’s cash flow smooth is more challenging than ever. That’s why Envizion’s proven processes deliver 95%+ clean claims submittals – so you can worry less about denials and focus more on patient care. Ready to take the pain out of practice management? Get a FREE Practice Analysis today! 👉 https://lnkd.in/gvFTQXRH #MedicalBilling #PracticeSolutions #MedicalPractice #EnvizionPracticeSolutions

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It’s crucial for supplemental benefits today to demonstrate clear value for both members and their health plan partners. This is a concept we understand well at Papa, having created and scaled a category-defining model—and we continually invest in research to further validate and inform our approach. Like our latest claims analysis that showed Medicare Advantage members who engaged in at least one #Papa visit were associated with a 9% reduction in medical costs. And the impact doesn’t stop there. 🚀 Members who engaged in more Papa visits saw even greater cost reductions, showing the potentially exponential impact long-term connection can have on an individual’s health, including: • 19% reduction in medical costs for members who average more than two Papa visits per month • 30% reduction in medical costs for members who average more than three Papa visits per month 📈 As plans look to enhance their offerings following the recent #CMS Star Rating recalculations, further investing in companion care is proven to maximize impact for your members. Learn how Papa can reduce healthcare costs and improve outcomes for your plan: https://lnkd.in/ejMf_But

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#MedicareAdvantage plans will likely see some benefit cuts this fall. Help fill gaps, both new and old, with hospital indemnity plans from carriers like Guarantee Trust Life Insurance Company and Wellabe. Randall Lobur and Jessica Schmaltz will show you how.

Since when did health insurance companies received thier “MD’s”? This is a long article but a fascinating read. We wonder why healthcare costs continue to escalate and premiums are unaffordable? Well, when you have insurance companies being able to add diagnosis’s and conditions to a members healthcare record which allows them to receive more money for treatment - oh and by the way these members don’t have these illnesses…rocket science not needed here! While this seems like its a “Medicare” problem - it’s happening everywhere. In your commercial and group health plan too. Providers trying to charge patients for negotiated discounts, millions of dollars in fake billings, pharmacy rebates being used to increase insurance company profits versus going back to the companies footing these bills or the patients using the drugs. Insurance companies and the organizations that own physician groups and hospitals have figured out how to game the system to increase profits - not deliver better health outcomes. I do believe that there are a lot of great professionals in the medical field that honestly want to improve the lives of people that they treat - they unfortunately now mostly work for companies that don’t really care much about that.

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For over 60 years, Boon-Chapman has been setting the standard for innovative and personalized health plan administration. As an independent TPA, we go beyond traditional solutions to deliver tailored strategies that prioritize both cost savings and member well-being.   Our member-first approach is driven by dedicated Boon Champions who provide 24/7 support and proactive care navigation—ensuring every member feels supported and empowered. Whether you’re a broker, employer, or partner, we’re here to help you build a better path forward.   Learn more about how we’re redefining plan administration in our latest blog. Click the link in the comments section below. #PlanAdministration #HealthcareSolutions #SelfFunding

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#MedicareAdvantage keeps getting more popular among seniors: #MA plans typically offer a range of supplemental benefits (like transportation/#NEMT) that can improve quality of life and health outcomes. But they are facing challenges headed into 2025, including lower star ratings, resistance from some health networks, rising healthcare costs, and a revised CMS payment model. Read our latest blog for a summary of MA changes that will impact health plans, providers, and members in the year ahead. https://hubs.li/Q02XP0700

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I always appreciate Sam’s posts as they are thoughtful and concise. What really upsets me about the letter from these Senators to CMS is how callously the word “brokers” is used in the paragraph below: —- “with more than $6 billion in MA plan spending on commissions and marketing, brokers are under pressure to churn through appointments as quickly as possible. The demand for volume means brokers are under pressure to focus on only a few plans and may not examine the full range of options” —- Let me be clear, the large majority of brokers are NOT under pressure to churn. We do NOT only examine a few plans. The actions being described are that of a call center. And therein lies the problem. The fact that our government officials clearly do not understand the difference between a call center and a broker is a tremendous problem. If we cannot educate our government officials regarding the difference, we are all going to be out of a career. Plain and simple. Pinnacle Financial Services, Inc. Tyler Insurance Group Angela Palo Kevin Shields Nick Palo NABIP Laura Tyler Andrew Horn, MHA Caroline Horn Eric Price, MBA Christopher Raon

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The CMS Health Equity Index will impact Medicare Advantage plans, but what should you do to prepare? It's time to take action. To learn more, read this executive summary from a recent webinar at https://splr.io/6043Wn8PH #HealthEquity

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Only 10 days left! 🕒 I-Med Claims' 𝐂𝐨𝐝𝐢𝐧𝐠 𝐔𝐩𝐝𝐚𝐭𝐞𝐬 𝟐𝟎𝟐𝟓 webinar is happening on September 26th. This is your chance to stay ahead with the latest ICD-10 updates. Learn from industry experts and gain the knowledge you need to improve your practice Don't wait—secure your spot today! 🔗 𝐑𝐞𝐠𝐢𝐬𝐭𝐞𝐫 𝐍𝐨𝐰: https://lnkd.in/dKvnEnAp #CodingUpdates2025 #ICD10 #MedicalCoding #Webinar #RegisterNow

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It is easy to get lost in the sea of insurance terms and acronyms. We have compiled a quick overview of the term “AEP” and what it means for you. #Insurance #Medicare

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ON-DEMAND WEBINAR: Is your RCM partner up to today’s security challenges? If you’re unsure, it’s time to find out. Watch to uncover how recent cybersecurity events have refocused vendor-selection requirements and what to evaluate during review.  #Cybersecurity #RevenueCycleSecurity #RCMSecurity

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Too many health decisions are made with incomplete information, and that’s driving a wedge between payers and providers. Can your claims pricing solution help solve the problem?    Rick Ellsworth, Zelis General Manager of Open Access and In-Network Pricing, touches on this in his latest blog and shares a few ways payers can improve provider communications in claims pricing. Check it out here: https://lnkd.in/enQp6jgZ

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Are you ready to unlock ERISA’s potential in managing insurance claims and denials? Join today’s Office Hours session, "Unlocking ERISA: Navigating Insurance Claims, Denials, and Recoupments," and learn how to use ERISA guidelines to protect patient claims and enhance revenue integrity. 11am PT / 1pm CT / 2pm ET Don't miss out – there’s still time to register: https://hubs.li/Q02yZVvH0 #ERISA #DenialsManagement #AI #RCMAutomation #MachineLearning

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