Mike Lundberg

What if patients became active participants in their own health? Could health insurance offer discounts for healthy behaviors like weight loss or managing cholesterol, similar to how auto insurance rewards safe driving? Ron Howrigon discusses the idea and the perverse incentives for payers to avoid unhealthy patients in this short from The Strain. Watch the full vidcast by visiting https://lnkd.in/eCs_2Mn9

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Boost Your Reimbursement: Overcome Denial Code CO15 By Almas Rizvi Learn how to overcome denial code CO15 with best practices for prior authorization and claim verification. Maximize reimbursements with expert RCM solutions from Claims Med. #DenialCodeCO15 #MedicalBilling #RCMOptimization #PriorAuthorization #HealthcareProviders #ClaimsManagement #ReimbursementSolutions

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𝗔𝘁𝘁𝗲𝗻𝘁𝗶𝗼𝗻 𝗣𝗹𝗮𝗻 𝗦𝗽𝗼𝗻𝘀𝗼𝗿𝘀: With changes to #MedicarePartD coming in 2025, employers still need to determine and disclose whether their prescription drug plan is creditable or non-creditable. The purpose of the notification requirement is to assist Part D eligible individuals make an informed decision about initial enrollment in Part D.

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From AI (early and often) to workforce shortages, hospitals, practices, and revenue cycle professionals are grappling with these seven pressing RCM trends right now. #AI #revcycle #RCM https://lnkd.in/eTVu8hYu

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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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Accurate Claims, Faster Payments Ensure timely and accurate claims submissions with MediCode. Our 98% clean claim rate on first submission means quicker reimbursements and fewer denials for your practice. 📍1650 Market Street, 36th Fl, Philadelphia, PA 19103 📞800-835-1264 🌐 medicode.online #ClaimsSubmission #MedicalCoding #DenialManagement #RevenueCycleManagement #RCM

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As healthcare organizations face increasing transaction volumes and staffing shortage challenges, the need to do more with less is crucial. Discover claim management tactics, time-saving tips, and advanced automation strategies that can help your team boost efficiency and streamline workflows for better results. https://lnkd.in/eRJsMe7p #ClaimManagement #RevenueCycle #Automation

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In today’s healthcare landscape, reducing insurance claim denials is critical for optimizing revenue and maintaining a smooth billing process. For podiatry practices, predictive analytics offers powerful solutions to identify high-risk claims, improve coding accuracy, and streamline the appeals process. By leveraging data-driven insights, podiatrists can proactively address denial patterns and ensure better claim acceptance rates. Learn how your practice can use predictive analytics to improve reimbursement and elevate patient care. #Podiatry #HealthcareInnovation #PredictiveAnalytics #RevenueCycleManagement #MedicalBilling #HealthcareTrends #PodiatryCare #ClaimDenials

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Unlocking the full potential of Artificial Intelligence in healthcare means addressing hurdles like physician buy-in, integration into workflows, and cost considerations. Insights from Baptist Health Medical Group's Dr. Oliver shed light on overcoming these challenges to drive value-based care forward. #Healthcare #ValueBasedCare https://buff.ly/3WwXsLY

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Building relationships and trust within your community is paramount. 😊 https://lnkd.in/g_RtsPBR #insurancesales, #medicaresupplement, #medicareadvantage, #lifeinsurancesales, #annuitysales, #healthinsurancesales

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Is Medicare Advantage really working for seniors, or just making insurers richer? Medicare Advantage (MA) was introduced in 2003 to involve private insurance companies in Medicare with the promise of reducing costs and improving care for seniors. However, it has failed to achieve these goals. Instead, it has become a highly profitable system for private insurers, costing taxpayers billions each year. Private insurance companies exploit Medicare’s billing system through practices where they classify patients as sicker than they are to receive higher payments. Studies show that between 2007 and 2023, MA plans overcharged the federal government by $612 billion. In 2022 alone, taxpayers overpaid MA insurers by $88-$140 billion. These costs are projected to grow, with an additional $600 billion in excess spending expected by 2031. Despite these issues, Medicare Advantage continues to expand, driven by aggressive marketing campaigns and gaps in traditional Medicare coverage. Seniors are often drawn to MA plans with promises of lower costs and better benefits. However, many face denied claims, canceled plans, and limited access to care. For example, 80% of mental health providers in MA plans were found to be unreachable or out of network. Additionally, denial rates for care increased by 55.7% from 2022 to 2023. Meanwhile, insurers profit significantly from the system. In 2021, MA plans earned $1,730 in gross profit per beneficiary, more than double their margins on regular insurance plans. Some insurers, like Cigna, have faced legal action for submitting false diagnoses to increase payments. Rather than continuing to overpay private insurers, policymakers could strengthen traditional Medicare by redirecting these funds. This would ensure seniors receive better care and reduce unnecessary spending, creating a system that benefits patients rather than corporations. #MedicareAdvantage #MedicareReform #HealthcarePolicy #SeniorsCare #MedicareFacts #HealthInsurance #HealthcareCosts #SeniorHealth #HealthcareReform

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Feeling overwhelmed by CMS's interoperability and prior authorization rule (CMS-0057)? You're not alone. This regulation brings critical changes for payers, with new compliance deadlines and technical requirements. Ready to tackle CMS-0057? Don't go it alone. Connect with Kendra Obrist or Brian Dwyer for personalized guidance and strategies to ensure your organization has a comprehensive strategy to ensure success. Reach out today to start navigating these changes with confidence!

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Insurance Discovery finds active primary, secondary, and tertiary patient coverage – as well as their Medicare Beneficiary Identifier (MBI) and demographic details – all in one quick inquiry. Get enhanced clarity on patient coverage, increased efficiency and accuracy in patient access, and improved back-end revenue cycle management (RCM) results, made possible by front-end success. Explore Insurance Discovery: https://ow.ly/OS9Y50RlHv7 #HealthcareSoftware #PatientAccess #InsuranceDiscovery #FrontEndRCM

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Register to close care gaps using CDI: https://lnkd.in/gXRqb3Be Healthcare disparities plague the industry, leading to worse health outcomes for specific member groups. Traditional administrative claims data often lacks the clinical granularity needed to expose the full picture. This webinar tackles the power of Clinical Data Integration (CDI) in identifying these hidden disparities. Leverage the expertise of Health Chain as we delve into how CDI programs can analyze clinical data to reveal: 🎯 Disparities in Dx/Px Rates: Unearth discrepancies in diagnosis (Dx) and procedure (Px) rates across different member segments. This unveils potential under-treatment or missed opportunities for early intervention in high-risk populations. 🎯 Preventive Care Gaps: Uncover potential differences in preventive care utilization across different member segments. Racial and ethnic minorities often experience lower rates of preventive screenings compared to white populations. 🎯 Leverage CDI to identify these disparities and develop strategies to close the gap and improve overall population health. 🎯 Social Determinants of Health (SDOH) Impact: Social factors like income, education, and access to healthy food significantly influence health outcomes. 🎯 Leverage CDI to identify SDOH impacting specific communities within your member base. Here from Nikita Ravindran and Vinay S. how Health Chain’s robust CDI solutions can be used to identify these disparities within your member population. Tune in at 1pm CST | 11am PST on 27th September 2024 to learn practical strategies to leverage rich clinical data captured through CDI for developing targeted interventions and improving health equity for all members. Bonus for attendees 📣 Get a free copy of Gartner’s report on “How Clinical Data Integration Improves U.S. Healthcare Payer Interoperability” #CDI #Caregaps #populationanalytics #healthcaredata #FHIR #payers #HCwebinars #Gartner Sudheen (Sudheendra) Kumar Mason Burr

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