W. Brian Kelly, CSSGB CLSSGB

Medicare Advantage leaders—don’t let Centers for Medicare & Medicaid Services deadlines catch you off guard. Meeting these dates isn’t just protocol; it’s vital to protecting your reimbursements and minimizing RADV audit risks. Our latest blog breaks it down: ✅ Key deadlines for 2024, 2025 and 2026 ✅ Compliance strategies that simplify submission ✅ Audit prevention tips to keep your team prepared Plus, download our 𝗙𝗥𝗘𝗘 𝗖𝗠𝗦 𝗦𝘂𝗯𝗺𝗶𝘀𝘀𝗶𝗼𝗻 𝗖𝗮𝗹𝗲𝗻𝗱𝗮𝗿 𝗣𝗗𝗙 to keep every critical deadline at your team’s fingertips. Stay ahead of compliance. Read the blog, grab the calendar, and secure your success for 2025 and beyond - https://bit.ly/4fLNUon . . . #CMSDeadlines #MedicareAdvantage #RiskAdjustment

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Join us in #Austin November 4–6 at the Texas Association of Health Plans conference! Connect with Phillip Cardona and other industry experts to discuss the current landscape of risk adjustment and quality—and let's talk about how we can collaborate to achieve your 2025 goals. #Texas #TAHP #AlwaysElevating #RiskAdjustment #QualityImprovement 

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📢 CMS Updates for LTC Facilities: Medicare Notices 📢 Stay compliant with the latest CMS updates on FTag 582! Key changes to the Notice of Medicare Non-Coverage (NOMNC) and Detailed Explanation of Non-Coverage (DENC) take effect on January 1, 2025. ✅ Educate staff on issuing NOMNC & SNF ABN ✅ Audit recent service terminations ✅ Review policies for compliance Check out our latest article to learn more! #LTC #MedicareCompliance #CMSUpdates

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As the use of artificial intelligence in healthcare claims management widens, the importance of careful oversight is needed. Any use of automation for claim denials should be scrutinized by providers to ensure the denial is appropriate. Read more at https://lnkd.in/e_yBqb4t

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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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For #healthcare providers, selecting the right medical claims clearinghouse is critical to optimizing claims processing efficiency, and enhances overall #revenuecyclemanagement. Read the blog post to learn about 5 key factors to consider when making this decision: https://lnkd.in/gaAuu5tp

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🚨 **CMS Updates for Medicare Advantage and Part D Plans** 🚨 CMS released the Final Rate Announcement on April 1, 2024, impacting Medicare Advantage (MA) and Part D (PD) plans. The changes must be factored into bids and business plans for 2025. On April 4, 2024, CMS issued the Final Rule (CMS-4205-F), updating the star rating system and other key elements for MA and PD programs, crucial for 2025 planning. Stay updated and adjust your plans accordingly! #Medicare #CMS #MedicareAdvantage #PartD #HealthcarePolicy

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New guidelines from CMS for the 2025 Medicare Advantage star ratings are making it more difficult for health plans to achieve or maintain high ratings. These changes will affect bonuses and the benefits plans can offer to members. Key Takeaways: - Higher Cut Points: Tougher thresholds across measures make it harder to score high. - Bonus Impact: Plans with 4+ stars earn key bonuses that fund benefits like zero-premium plans. Fewer high ratings mean fewer bonuses. - Tukey Method Uncertainty: New volatility has resulted in the highest star rating cut points ever. - Challenges for Insurers: Major players like Humana are seeing drops in highly-rated plans. - Focus on Quality: Plans need to close care gaps, engage members, and collaborate with providers to adapt. How We Can Help: Along with our PERS devices, Best Buy Health offers services to help boost Medicare Advantage star ratings: - Social Care Support: Address social needs for better member health. - Digital Literacy: Empower members to use health technology effectively. - Fall Detection & Urgent Response: Ensure timely interventions for member safety. - Health Risk Assessments (HRAs): Close care gaps and improve outcomes. These solutions enhance member experience and can support the quality metrics needed to help plans meet their star rating targets. Read the full article from Lauren Berryman at Modern Healthcare: https://lnkd.in/g38DNir3 #MedicareAdvantage #CMS #StarRatings #HealthcareQuality #BestBuyHealth #MedicarePlans #HealthInsurance #PERS

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As healthcare providers continue to navigate the complexities of modern claims management, the latest data from a 2024 report paints a concerning picture: denial rates are rising, complicating revenue collection and creating a cascade of operational challenges. Click the link to read more: https://lnkd.in/gHtCYsBE #denialmanagement #practicemanagement #revenuecyclemanagement #medicalbillingcompany

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📢 Curious about the Inflation Reduction Act? Dive into this article to get the key details and what it means for you! 💡📈 https://bit.ly/4draMc6 #InflationReductionAct #StayInformed #Medicare #AEP2025 #AnnualEnrollmentPeriod #StayInformed #Healthcare #MedicareAdvantage

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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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Join us TODAY, 1 p.m. ET for an AHCJ webinar examining what actions states — which regulate the insurance industry and run the Medicaid programs — have taken to increase spending on primary care and what effect these efforts can have on costs. 🔗 https://lnkd.in/d6uxeH4j

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In the concluding segment of our collaborative research with Harvard Medical School, we delve into the intricacies of plan design for Medicare and Medicare Advantage enrollees. Explore the following questions to gain insights into this vital aspect of healthcare. Discover the answers and our research findings here >> https://ow.ly/3xH950Rhf38 #MedicareAdvantage #HealthEquity

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  Earlier this year, Centers for Medicare & Medicaid Services provided guidance encouraging #PACE organizations to start submitting risk adjustment data using the Encounter Data System.   Will the transition impact program risk scores or reimbursement? Read our blog post to find out and get answers to other key questions.   👉 Learn more: https://lnkd.in/eQ4dTmCQ #RiskAdjustment #ValueBasedCare

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With over 2 million members displaced by major healthcare players exiting underperforming Medicare Advantage markets, regional insurers face both a challenge and an opportunity. This influx of high-cost members demands innovative solutions to manage chronic conditions like diabetes and heart failure effectively. At Circadian Health, we’re helping regional insurers navigate this disruption with virtual-first specialty care, reducing costs and improving outcomes for the most complex members. This market shake-up isn’t just a challenge—it’s a chance to redefine care delivery. Discover how regional insurers can transform disruption into opportunity—read more on our blog. #MedicareAdvantage #HealthcareInnovation #VirtualCare #CircadianHealth #ValueBasedCare #HealthEquity

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