Michelle Frank

Navigating the reimbursement landscape poses significant challenges for NEMT providers, and can impact their ability to deliver consistent and reliable transportation. Complex reimbursement models, delayed payments and regulatory compliance are just a few challenges faced on a daily basis. So how might we address these issues? ➡ Advocate for Policy Reform: Unite to push for more transparent and equitable reimbursement policies that recognize the critical role of NEMT. ➡ Enhance Operational Efficiency: Invest in technology and training that can streamline processes, reducing errors and improving turnaround times for claims. ➡ Foster Collaboration: Build partnerships with healthcare providers and payers that create a more integrated system that supports patient needs. Let's drive change, and ensure that patients have the reliable transportation they need! #NEMT #ReimbursementChallenges #PatientTransportation

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Provider Lifecycle Management (PLM) Software by Newgen Software How and what around: A) Provider Contracting B) Provider Data C) Provider Credentialing D) Prividers Appeals https://lnkd.in/eNV4q5_H

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While the rule is getting phased in for #medicaid payments, it's wise to start leveraging technology to improve both Patient and Employee onboarding. #homehealthcare #consenting #electronicsignature

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In this video series, listen in as Optum Advisory experts @Jeremiah Reuter and @Aaron Jurgaitis share their perspectives on how to adapt to constant changes in health care and leverage data to help care coordination. Watch part 1 here: https://optum.co/wqeyrq Watch part 2 here: https://optum.co/00xw8i #provider #healthcare #OptumAdvisory #Optum #healthcareperspectives #carecoordination #healthcaredata #healthcareconsulting

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Medicaid in many ways is paving the way for value-based payments. Many states are taking innovative approaches and requiring MCO/provider participation in risk arrangements. As one of the largest VBP platforms operating in Medicaid, we get the privilege of aggerating these APMs to better enable provider success. Please come by our booth to see how we can help your provider network and health plan teams better operationalize and support VBP performance and growth.

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Struggling to recruit caregivers? You're not alone—caregivers are one of the toughest roles to fill in the U.S. That’s why HHAeXchange put together their top seven tips to help homecare agencies hire quality caregivers quickly. Download the guide here:

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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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It’s all about the Data. To get to a digital future in healthcare, to have good AI, to transform into delivering personalized care, to make care more equitable and accessible, harnessing the Data is everything. Thanks to Rich Waller and WellStack for the conversation and making data liquidity their mission.

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Really interesting article. ASC operations are proving crucial for the successful adoption of value-based payment systems and evolving healthcare as we know it. Strong operational foundations inherently lead to economic success and greater flexibility in adopting new care models, which in turn improves patient outcomes. #ASCs #Healthcare #PatientCare

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Many teams say they want to be great, but how do they know if they are? This is a chance to find out! Celebrate your performance and see if you are truly a top 10% team in healthcare TA! #benchmarks #analytics #healthcare #talentacquisition #roguehire

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The clinical dashboard is a key aspect to ensure strong patient care and streamlined operations for providers. Not only is the data important, but the insights are what really makes the difference for both parties. I enjoyed speaking with Skilled Nursing News about what needs to be included in the dashboard, and the overall impact this type of technology can have on the entire healthcare system. Thanks again for the opportunity!

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Leaders from across Hartford HealthCare came together for our Annual Quality & Safety Summit, a national conference-caliber event where healthcare professionals, executives, and board members confront the challenges of our time and craft solutions that matter. The focus this year was sobering yet essential: Reimagining Maternal Fetal Health given the worsening state of maternal and infant health in our country. National inequities are growing, with an alarming increase in preventable harm for Black and Hispanic mothers and babies. The care and outcome gaps, which once seemed contained, have widened, underscoring the urgent need for action. The data presented was difficult to hear, and the room carried the weight of its implications. Yet, amidst the grim realities, there was a determined energy to do more—together. The numbers are not good across the country, but also not in our state. We know this issue demands a collective response as a system. In the central region, we’ve set a bold goal for 2025: advancing our Zero Harm metric for maternal and infant preventable harm. But we understand that addressing this crisis goes beyond improving our internal practices. We must also connect deeply with our communities—empowering not just birthing individuals but their entire support networks. Our Quality & Safety Summit sparked vital conversations and ignited the light bulbs we need to illuminate the path forward. Improving maternal and infant health outcomes is a monumental challenge—but it is one we are committed to meeting head-on. We need to create a future where every mom and baby has a chance to thrive. And I’m grateful to be here as part of the solution. MidState Medical Center The Hospital of Central Connecticut #IBelongHere

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What is the bottom line if you have financial responsibility for a provider group? Your competitors have the ability to know your contracted rates for everything you do. That's the bad news. The good news is that you can know theirs to help you in your next negotiation.

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Site-neutral payments refer to a Centers for Medicare & Medicaid Services policy in which the same medical services are reimbursed at the same rate, regardless of where they are provided. Currently, our healthcare system does not widely use this approach, with reimbursement rates varying based on the type of facility. However, there is increasing interest in expanding site-neutral payment reforms. I recently wrote a blog on this topic for The Alliance. Click below to learn how Medicare's site-neutral payments policy is emerging as a strategy to manage healthcare costs and what it could mean for self-funded employers. https://ow.ly/a82Y50T8Lpo

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In the past few years, cybersecurity has been a major conversation in the healthcare industry. As we face higher rates of cyberattacks, states like New York have taken measures to tighten up regulations. If your health facility operates out of New York, here’s what to keep in mind: conducting annual risk assessments, creating a dedicated cybersecurity program, and implementing a cybersecurity policy up to the new standards. New York is also requiring hospitals to have on-site staff dedicated to upholding and updating these measures on a regular basis. To uphold these regulations and protect patient safety, healthcare facilities can also work with security specialists to strengthen security on the ground as well. I am glad to see so many hospitals coming together around the nation to respond to this need. #cybersecurity #healthcare #HealthRegulations

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In a recent article, The Philadelphia Inquirer reported that two Aledade, Inc. Accountable Care Organizations (ACOs) were the Philadelphia area's top performers in the Medicare Shared Savings Program in 2023. They achieved higher savings rates and shared savings totaling over $38 million compared to the other ten ACOs in the region. In addition, Aledade's Delaware and New Jersey ACOs, both with practices in the Philadelphia metro, earned shared savings of more than $14 million. https://ow.ly/hyw950UehHH

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In a recent article, The Philadelphia Inquirer reported that two Aledade, Inc. Accountable Care Organizations (ACOs) were the Philadelphia area's top performers in the Medicare Shared Savings Program in 2023. They achieved higher savings rates and shared savings totaling over $38 million compared to the other ten ACOs in the region. In addition, Aledade's Delaware and New Jersey ACOs, both with practices in the Philadelphia metro, earned shared savings of more than $14 million. https://ow.ly/81rq50UehII

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In a recent article, The Philadelphia Inquirer reported that two Aledade, Inc. Accountable Care Organizations (ACOs) were the Philadelphia area's top performers in the Medicare Shared Savings Program in 2023. They achieved higher savings rates and shared savings totaling over $38 million compared to the other ten ACOs in the region. In addition, Aledade's Delaware and New Jersey ACOs, both with practices in the Philadelphia metro, earned shared savings of more than $14 million. https://ow.ly/52as50UjCO9

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Are sepsis and pressure ulcers the next wave of the OIG's high risk HCCs to be audited? This report leads me to believe they are reviewing them more aggressively and could include them in their next HCC toolkit. The article below is the second article the OIG released on 9/25. It will take some time to review it in depth but what immediately jumped out to me is that there are some new high risk categories that were reviewed. While sepsis was also included in the Humana report released today, this is the first time I remember seeing pressure ulcers as a high risk category. What is core to every targeted review is that the OIG looks for conditions captured once and only once in a calendar year. I have been preaching about this since 2018. Six years later organizations still struggle with this concept and in particular identifying where risk may be. Let's talk about it. In this review, 269 conditions were reviewed for documentation sufficiency. -93.3% of strokes, heart attacks, and cancers were found not to have sufficient documentation to support the HCC. -57% of sepsis cases lacked supporting documentation -31% of pressure ulcers lacked supporting documentation Here is the criteria for including sepsis and pressure ulcers in their targeted reviews: Sepsis- An enrollee received one sepsis diagnosis (that mapped to the HCC for Septicemia, Sepsis, Systemic Inflammatory Response Syndrome/Shock) on one physician or outpatient claim during the service year but did not have a sepsis diagnosis on a corresponding inpatient hospital claim. A sepsis diagnosis generally results in an inpatient hospital admission. Pressure Ulcers- An enrollee received one pressure ulcer diagnosis that either mapped to the HCC for Pressure Ulcer of Skin with Full Thickness Skin Loss or the HCC for Pressure Ulcer of Skin with Necrosis Through to Muscle, Tendon, or Bone (Pressure Ulcer HCCs) on only one claim during the service year but did not have a pressure ulcer diagnosis on another inpatient, outpatient, or physician claim for either the calendar year before or the calendar year after the service year. Individuals diagnosed with the most severe types of pressure ulcers generally receive treatment on multiple occasions. I am inclined to believe that even though the rejection rate for sepsis and pressure ulcers are lower than MIs, CVAs, and neoplasms that these may be included moving forward. Historically depression has been included for similar reasons but it seems to have dropped off in recent reviews. I will stress again... KNOW YOUR DATA. If you don't know your data you are at risk. You also can't have a strong CDI program if you don't first know your patients, what conditions they have, and what suspect conditions may be lurking. https://lnkd.in/ebh9-AyY

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