Todd Ryan

📢 Attention Healthcare Providers: Are You Ready for MIPS 2024 Final Rule Compliance? With the 2024 MIPS Final Rule introducing new performance thresholds, updated measures, and reporting changes, it's essential to stay ahead and ensure compliance. At ReportingMD, we specialize in simplifying the MIPS reporting process to help you meet CMS requirements while maximizing your performance scores. Here's how we can help: ✅ MIPS Reporting & Submission: Our easy-to-use platform ensures accurate data capture and submission. ✅ Expert Guidance: Our team of Dedicated Advisors provides personalized support to help you navigate the latest MIPS Final Rule changes. ✅ Performance Analytics: Get actionable insights to improve performance and maximize your incentives. ✅ Compliance Assurance: We minimize your risk of penalties with comprehensive compliance support. Whether you’re new to MIPS or looking to optimize your strategy, ReportingMD is here to support you every step of the way. 💡 📅 Let's talk! Contact us to schedule a consultation or learn more about how we can help you stay compliant and succeed with MIPS in 2024.

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LeadingAge24: Create Efficient Senior Care Workflows with Interoperability - HealthTech Magazine At LeadingAge24, the focus is on leveraging interoperability in healthcare IT to enhance senior care workflows amid ongoing staffing shortages. With 93% of nursing home providers facing significant workforce challenges, integrated health IT tools can streamline operations, allowing caregivers to focus on patient care rather than administrative tasks. By adopting electronic health records (EHRs) and automating scheduling, organizations can improve job satisfaction and care quality. As we move towards standardized interoperability across states, the potential for better outcomes and staff retention becomes increasingly vital. #HealthcareIT #Interoperability #SeniorCare #EHR #HealthTech #PatientCare #LeadingAge24 ai.mediformatica.com #health #healthtech #healthcare #interoperability #workflows #staff #seniorcare #nurse #tools #nurses #acutecare #postacutecare #digitalhealth #healthit #healthcaretechnology @MediFormatica (https://buff.ly/3Up9Gq0)

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This article shares expert tips on how to improve patient registration, streamline payment processes, and leverage technology to improve your #RCM efficiency.

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Prior Authorization Reforms: A Step Towards Easing Provider Burdens? Three more states have taken significant steps to reform the often burdensome prior authorization process for healthcare providers and patients. Illinois, Oklahoma, and Vermont have all passed new legislation aimed at bringing more transparency, efficiency, and fairness to prior authorization requirements imposed by health insurers. These reforms come at a time when providers across the country are grappling with the administrative complexities and delays caused by prior authorization protocols. While intended to control costs and ensure appropriate care, the process has become a source of frustration, potentially impacting patient outcomes and provider burnout. The new laws introduce measures such as: 🔑 Mandatory public disclosure of all services requiring prior authorization 🕰️ Strict timelines for payers to respond to urgent and non-urgent requests ⚖️ Independent clinical review of denials by same-specialty providers 🚫 Bans on prior authorization for certain services like inpatient psychiatric admissions While these changes are a positive step, concerns remain about the potential impact on insurance rates and healthcare costs. Vermont's governor has called for a comprehensive study to evaluate the effects of such reforms on outcomes, costs, and premiums. As the healthcare landscape continues to evolve, striking the right balance between cost control, administrative efficiency, and quality patient care remains a delicate challenge. These state-level initiatives highlight the growing recognition of the need to streamline prior authorization processes and reduce unnecessary burdens on providers. The ultimate success of these reforms will depend on effective implementation, continuous monitoring, and a willingness to adapt and refine the measures based on real-world outcomes and stakeholder feedback. What are your thoughts on these prior authorization reforms? Do you believe they will meaningfully improve the provider and patient experience, or are more comprehensive changes needed? I'm curious to hear your perspectives. Read more about these reforms: https://lnkd.in/efeR26eu

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Maximizing efficiency in utilization review and case management is essential for optimal patient care. Explore five innovative strategies to enhance these processes, including leveraging technology, data analytics, and interdisciplinary collaboration. Learn more in our latest Insight post: https://lnkd.in/ekjBB8v9 #UtilizationReview #UM #CaseManagement #QualityCare #BHMHealthcareSolutions

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Lots to unpack in the below article around the Nursing Home staffing rule. CMS has issued updated guidance that surveyors will use to weigh nursing homes’ compliance with expanded facility assessment requirements included in the minimum staffing rule. Also, for the first time, providers are explicitly directed to consider behavioral health needs of patients, as well physical needs, cognitive limitations and chronic conditions in addition to updated new criteria.

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If you build it, will they come? I’ve heard countless organizations - #MA plans, #Medicaid plans, risk-bearing providers, vendors, PBMs, and retail players - say “we need to build the capabilities to XX”. Many are looking to vendors for solutions, but few vendors are ready to invest in new capabilities without contracts.  Anyone else sensing this (problematic) new conundrum? Here’s my quick take and a few ideas to break through this barrier. Many sales meetings are often held with functional departments, and often do not include the #MedicareAdvantage #StarRatings, #RiskAdjustment, #HEDIS, IT or P&L owners. We must collaborate to get those departments’ urgent needs integrated into new vendor purchases in order for new activities to meet new and emerging needs, remembering that: 🌟 Vendors are vital to your success.  🌟 Vendors operate in a more volatile environment than plans. 🌟 Vendors have smaller budgets than plans. 🌟 Vendors need signed contracts to make significant investments.   🌟 Vague RFPs waste vendors’ time and resources. Collaboration creates win-win contracts which expand capabilities of both parties. I encourage plans to: ✅ Ask vendors about their roadmap; including timing and certainty of planned enhancements. ✅ Include the #Stars, Risk Adjustment and #PartD teams in new vendor discussions. ✅ Consider adding a vendor's roadmap capabilities to contracts. ✅ Co-create with trustworthy vendors. I encourage vendors to: ✔ Ask about the customer’s unmet needs. ✔ Offer to co-create solutions to new and emerging needs with willing customers. ✔ Offer to accelerate roadmap capabilities with willing customers.   ✔ Articulate the things you would be willing to do if a customer would be willing to contract for it. This is a #MarketMakingMoment as #CMS has thrown down the gauntlet with #NewNeedsOfStars and #NewNeedsOfMA. This is a stellar time for vendors to review current and planned capabilities with a broader lens on new and emerging MA, #Compliance, Stars, #ECDS, #Interoperability, #HealthEquity, Medicaid & #SNP Aligment, and Risk Adjustment needs. If you need help, reach out to us.  #WhatGotYouHereWontGetYouThere  ⭐ ⭐ ⭐ ⭐ ⭐

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With healthcare landscapes constantly evolving, understanding the latest CMS requirements for Medication Therapy Management (MTM) programs is crucial. This comprehensive guide by Clarest provides a roadmap for payers to stay compliant and ahead of the curve. Learn about key changes, strategic implementation tips, and best practices to ensure your MTM programs meet CMS expectations. Stay informed and make informed decisions for your healthcare programs. Click the link below. #Healthcare #CMS #MTM #Payers #Compliance

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If I asked you to choose between Trader Joe's or Target, which would you choose? It's a silly question, really. Because both offer unique benefits. As major GPOs shift in the market, exclusive agreements are becoming common. But are they truly driving value for health systems and patients? Exclusive GPO contracts limit choice. It's like forcing someone to choose between Trader Joe’s and Target. At Advantus Health Partners, we offer diverse vendor partnerships and PPI contracts, enhancing both economic benefits and patient care. By rethinking exclusivity, we prioritize patients and empower health systems with choice. Ready to supplement your supply chain with value-added partnerships? Contact Advantus today to learn more about our non-exclusive contracts. https://lnkd.in/deiYRgfE #SupplyChainStrategy #GPOExclusivity

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Proactive point-of-care CDI just got smarter. Queryless CDI™ integrates directly into Epic, providing real-time CAPD suggestions—so you can focus on care, not corrections. The future of clinical documentation is here. ➡️ Learn more: https://rb.gy/m2dlti #Epic #CDI #ProactiveCDI

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🏥 According to Kaufman Hall and Sg2, emergency department visits increased this past year, boosting operating margins by 21%. While the increase in patient volumes presents ample opportunities for #HealthSystems to increase revenue, their revenue cycle management (RCM) departments must also be prepared.    ✅ Best practices for #RCM team preparedness include education on how to optimize current technology and workflows while also incorporating new tools such as RPA, ML and AI. A sustainable revenue cycle requires continual training, proactive workflow assessments, and data expertise to manage the volume increases ahead. 💡 How can e4health help? Learn more here: https://lnkd.in/ede-Wk6Y Article Source: https://lnkd.in/eYSZehPa -------------------------------- #e4health #EmpoweringBetterHealth #RevenueCycle

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As more payment models require hospitals and providers to report on and address SDOH, they will need the right tools to ensure they understand a patient's social needs and are able to address them, Buckley said. #health #qualityofcare #socialdeterminantsofhealth #sdoh #dataanalytics #healthequity #populationhealthmanagement #valuebasedhealthcare #SDOH #valuebasedcare #vbc #integratedhealthcare #integratedhealthcaresystems #healthtech #Persivia #PersiviaAI

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💡New #Avalere Study 💡Do #340B contract pharmacies serve patients in rural areas? Do 340B hospitals contract with chain or independent pharmacies? Our team crosswalked a couple of data sets to get some snapshots of trends in contract pharmacy use in 340B to inform the ongoing debate in Congress. Reach out to learn how we can help you with policy design and analytics. #drugpricing #drugs #lifesciences https://lnkd.in/evXZRZ2N

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The 2024 HealthLeaders Exchange RevTech Exchange in Nashville highlighted eight essential tips for effective revenue cycle management (RCM) technology. First, continuous training is critical due to AI-driven changes; RCM staff must evolve from manual tasks to monitoring automated processes. Leaders must address AI-related job concerns and help staff adapt to their new roles. Technology alone isn’t a solution; it’s a tool requiring effective utilization to improve revenue cycle performance, as seen in WVU Medicine's predictive denial tool that lacked actionable value. Second, health systems must proactively address root causes of common RCM pain points, such as denials and prior authorizations. Third, cross-department collaboration, particularly with IT and clinicians, is essential; RCM staff should understand clinical workflows and find clinician champions to improve technology alignment. Fourth, securing a clear ROI is crucial to justify AI investments, and fifth, balancing new and established tech requires strategic decisions on in-house versus outsourced solutions. Sixth, learning from other industries like retail and banking can bring fresh perspectives to RCM, fostering innovation and adaptability across healthcare systems. Our RCM team supports effective revenue cycle technology management by offering tailored training on evolving tech, fostering cross-department collaboration, and addressing root causes in areas like denials. We help healthcare entities maximize ROI, balance new and established tech, and adapt successful strategies from other industries for seamless integration. #HomeHealthServices #HospiceCare #FrontEndServices #BackOfficeSolutions #HealthcareManagement #RevenueCycleManagement #HealthcareCompliance #PatientSupport #CareCoordination #MedicalBilling #ClaimsManagement #PatientEngagement #HealthcareOutsourcing #MedicalCoding #ProviderSupport #CliniqonCare #HealthcareSolutions #PatientCareExcellence #HomeHealthRCM #HospiceBilling

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CVS' Oak Street Health to open clinics at retail pharmacies - those that do not learn from history are doomed to repeat it 1) There is very little evidence that, in recent years, a stand-alone primary care business will do anything but generate deficits. 2) The days of MA generating windfalls for PCPs are numbered due to recent premium reductions and regulatory oversight over the rampant abuses relating to Risk Scoring, PBMs, Prior Authorization, etc. Also, providers are refusing to contract with MA plans given their yield of 80-90% of Medicare and the overhead cost of dealing with denials, delays, and down coding, thus threatening network adequacy. Hospitals report they are frustrated with select CVS-affiliated MA plans taking up to four days to authorize transfers to nursing homes, requiring the hospital to absorb the cost of "unnecessary" days. 3) EBITDA must come from somewhere: a) better commercial contracts (not likely,) b) improved efficiencies (not in a large corporation,) MA risk (see above), an ASC (not for PCPs) and/or reduced physician compensation (highly probable.) This business model has not been sustainable in the past - what is different this time? We have seen this movie before. So it goes n8 #hospitals #healthsystems #medicareadvantage #primarycare #valuebasedcare

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