Scott Schlesner

Prior authorizations can be a roadblock to timely reimbursements in urgent care. Explore strategies to streamline the process, improve workflows, and accelerate cash flow. Read More: 👉 https://shorturl.at/l6PGk #medicalbilling #cashflow #reimbursement #Healthcare

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At Iodine, we know that accurate documentation is crucial. That’s why we’ve developed AwareCDI, powered by CognitiveML, to ensure your records tell the real story of your patient care. In our latest blog, discover how AwareCDI: - Enhances documentation integrity - Boosts capture of key comorbidities by 23% - Improves quality scores across the board Don't let documentation inaccuracies hold you back. Learn how you can elevate your hospital's true quality and receive appropriate reimbursement. Click Here to read our latest blog: https://shorturl.at/4JoLx #healthcaretech #healthcareAI #quality #innovation

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The 2024 CMS Priori Authorization rule was passed to reduce burden for providers, members and Payers for data exchange and approval process, however work must be done for payers and providers. Some provisions and policy adoption are required (January 2026) and data exchange integration by January 2027. This article provides an overview of the policy, provisions and requirements, as well as some guidance to build your strategy to meet the requirements. https://lnkd.in/gp32MjUN

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Value-based care (VBC) is reshaping healthcare by emphasizing outcomes and cost efficiency over volume. Originating from managed care models in the 1980s, VBC has evolved with a strong focus on refining payment models, enhancing care coordination, and improving patient outcomes. Key players, including clinical data registries, ACOs, and payers, are crucial to this transformation. By collaborating, sharing data, and aligning incentives, these stakeholders drive advancements in care quality and efficiency. Learn more about how these collaborations can enhance VBC in this Health IT Answers article. https://lnkd.in/gxSPZAgM

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Big data is transforming healthcare, from improving patient care to optimizing workflows, data-driven insights help providers make informed decisions and boost efficiency. Learn how predictive analytics can personalize care, prevent complications, and cut costs—all while driving top performance in healthcare systems. Hear directly from Vizient's CMO and a leading academic medical center expert on strategies for achieving and maintaining top performance.

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Update to MA 2025 Final release ( more details are still required). The final (4/23/24) introduces changes to the regulations concerning agents, brokers, and Third-Party Marketing Organizations (TPMOs) in several areas: Unified Compensation Framework: The new regulations implement a unified compensation structure for agents and brokers across all plans. A single compensation rate is set for all plans, updated annually, which also includes a revision of the scope of items and services within agent and broker compensation. Separate payments for administrative services by agents and brokers are eliminated (administrative is defined but more details coming). Oversight and Compliance: Enhanced oversight measures are introduced to ensure that agents, brokers, and TPMOs (includes FMO’s) comply with the updated compensation structures and marketing rules. TPMO Marketing and Data Privacy: TPMOs are now subject to stricter marketing and communication rules. The final rule prohibits TPMOs from selling or sharing personal beneficiary data collected during marketing activities without explicit beneficiary consent. A new one-to-one consent structure is required, where TPMOs must obtain explicit consent from the beneficiary for each TPMO that will receive their data, ensuring more transparent and controlled use of beneficiary information. Prohibitions on Overrides: The regulations explicitly prohibit compensation structures that include additional payments known as "overrides" for TPMOs, which could influence the marketing and enrollment practices in favor of higher-paying plans. As we all know this will need further evaluation but recordings; trainings; portals etc will all be included in the total capped enrollment comp. #MAfinal2025 #medicareadvantage

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More interesting #news today on #carecoordination and transitions of care, this time specific to bundled payments for hospitals and the #TEAM model. #CMS #Healthcare #reimbursement

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Azara DRVS helps healthcare providers manage patient populations living with asthma by using data-driven tools to improve patient outcomes. Learn more about how our clients are putting data into action in Kaitlyn Gordon's latest blog: https://hubs.la/Q02yHFPg0 #AsthmaAwarenessMonth #AzaraDRVS

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Save money, understand your asset portfolio, make sharper planning/purchasing decisions? Win. Win. Win. #Arrevo #medicalequipment #capitalplanning #assetmanagement

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Disparate systems promote disparate processes because each system often operates in isolation, lacking interoperability and consistent data flow. This fragmentation leads to inefficiencies, misaligned workflows, and poor coordination across departments. For healthcare organizations, this disconnect hampers the ability to deliver cohesive, patient-centered care and makes achieving goals like improved outcomes, reduced costs, and streamlined operations harder. In today's competitive and value-driven landscape, healthcare organizations can't afford such inefficiencies—they need integrated, data-driven solutions that promote alignment and enable seamless processes across the board.

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There's a lot to this article to consider. It freely admits the difficulty associated with success in VBC programs unless huge investments are made in data analytics and infrastructure. These types of investments are hard to support for smaller organizations such as IPA's, rural hospitals, etc. Unless an organization is prepared to take full risk on Medicare lives, the challenges associated with VBC operations (both Medicare and Commercial) in our current environment are difficult to manage. This is doubly important when you are faced with asking doctors to change work flows and processes with the promise of potential dollars 16-18 months downstream. Adoption of these programs will not truly hit a tipping point until we find a way to pay our providers in real time for the outstanding work that they are doing everyday. (I.e. it shouldn't take three additional codes to justify that blood pressure was measured during a visit. I can't go to a dentist without having my BP measured.) Patient Physician Network #Libertatem P.S.> Thinking that handing off 50+% of the Medicare lives to major payors operating MA programs will fix this is flawed also, in that they will undoubtably seek reductions from the very providers that they are asking for behavior change from.

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Oracle Health announced plans to launch a next-generation EHR platform in 2025, incorporating advanced cloud and AI capabilities. This new EHR will feature Oracle's clinical AI agent, voice-activated navigation, and Health Data Intelligence, which integrates patient data from over 300 sources to enhance clinical workflows and improve patient outcomes. The platform aims to replace traditional EHRs, which often dictate rigid workflows, with a more dynamic system that allows for personalized care plans. Oracle Health emphasizes that the new EHR is a complete reinvention rather than an upgrade of the previous Cerner system. Additionally, Oracle plans to become a Qualified Health Information Network to facilitate standardized data sharing across the healthcare ecosystem. Executives at Oracle also unveiled new cloud applications to improve patient management and streamline front-office operations, reinforcing the company's commitment to enhancing healthcare accessibility and data utility while addressing interoperability challenges in the industry.

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We're featured in #BeckersHealthcare! Our 2024 #CompassSurvey reveals insights on clinician involvement in software decisions and the need to streamline workflows in #healthcare. Check out 7 key findings and their impact on #healthcaretech! #symplr

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CMS Introduced the Transforming Episode Accountability Model (TEAM) model. The proposed mandatory TEAM model would begin on January 1, 2026, and end on December 31, 2030 and signifies a significant shift towards value-based care and patient-centric models. What exactly is the TEAM model, and why is it generating buzz across the healthcare landscape? 1. Episode-Based Alternative Payment Model: TEAM represents a bold step towards episode-based alternative payment models. It builds upon the successes and lessons learned from previous models like the Bundled Payment for Care Improvement Advanced (BPCI-A) and Comprehensive Care for Joint Replacement (CJR) models. 2. Incentivizing Care Coordination: TEAM aims to incentivize care coordination, improve patient transitions, and reduce avoidable readmissions for beneficiaries undergoing specific procedures. By holding hospitals accountable for the cost and quality of care throughout the episode, TEAM promotes efficiency and quality across the care continuum. 3. Participation and Episodes: Under the proposed model, participation would be mandatory for acute care hospitals within selected core-based statistical areas (CBSAs). Episodes would cover a range of procedures, including lower extremity joint replacement, spinal fusion, and major bowel procedures, starting from hospitalization to 30 days post-discharge. 4. Economic Framework: CMS will establish target prices covering most Medicare Parts A and B spending during episodes. Hospitals will be reimbursed based on their performance compared to these targets, with adjustments for patient risk factors. 5. Participation Tracks: TEAM offers three tracks with varying levels of financial risk and quality performance adjustments, accommodating different hospital types and preferences. 6. Flexibilities and Initiatives: To support care coordination and innovation, CMS proposes flexibilities such as safe harbors for financial arrangements and beneficiary incentives. Additionally, TEAM includes a pioneering Decarbonization and Resilience Initiative, emphasizing climate resilience and sustainability. #CMS Centers for Medicare & Medicaid Services #HealthcareInnovation #ValueBasedCare #TEAMModel #PatientCentricity #HealthcareTransformation

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How is your organization using AI for documentation? It seems this is one of the most useful forms of AI right now in healthcare, which is giving physicians back their time to focus on the patient. We upgraded Synapse 2.0 with an ambient AI, Nirvana Notes, which captures information from phone calls and video calls between the virtual neurologists, onsite care teams and patients. It has cut our documentation time down to minutes. Sevaro #telestroke #teleneurology Becker's Healthcare

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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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🚨 The Centers for Medicare & Medicaid Services (CMS) has proposed a new mandatory payment model called the Transforming Episode Accountability Model (TEAM) as part of the fiscal year (FY) 2025 Hospital Inpatient Prospective Payment Systems (IPPS) rule. 🏥 Swipe to learn more about this and see how Persivia Inc. can help. 💡 #health #qualityofcare #dataanalytics #healthequity #TEAM #populationhealthmanagement #valuebasedhealthcare #valuebasedcare #vbc #integratedhealthcare #integratedhealthcaresystems #healthtech #Persivia #PersiviaAI

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Check out this insightful webinar about how RPM and virtual WOCNs can change the game clinically, operationally and financially for our payers, providers and patients #remotepatientmonitoring #virtualwoundcare #healthrecoverysolutions #innovation https://lnkd.in/gdsgpP4T

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