Stuart Newsome, CPCO’s Post

What’s your first move when you receive a RAC audit letter? For many healthcare practices, this moment can be overwhelming—but it doesn’t have to be. In our first episode of the RAC Audit Series, Infinx experts Julie Graham, HCA-BA, CPC, CCC and Kristeen Coronado will share how to navigate that crucial moment when an audit begins. Get practical tips for interpreting the audit letter, assembling your documents, and avoiding common pitfalls. Don’t miss it! Register here: https://hubs.li/Q02QMjZP0 #RevenueCycle #DenialsManagement #RACAudit #RCMAutomation #HealthcareFinance

As promised, weekly price transparency news summary #2! It takes a lot to move a market, but there's a lot happening in the world of healthcare price transparency. Follow Simple Healthcare to make sure you're keeping tabs.

Price Transparency News from the Week of Nov. 3rd through Nov. 10th The HHS OIG conducted an audit (https://bit.ly/40CTXYe) of 100 hospitals and found that only 37 fully complied with requirements to make pricing data available. Stronger reviews and penalties are needed to encourage hospitals to fully comply with transparency regulations.   Minnesota’s newly approved price transparency law (https://bit.ly/4hDdHBb) will become effective in January 2025, mandating disclosure of all mandatory fees for goods and services. The law is significant as it strengthens consumers’ protection by ensuring transparent pricing and state oversight. A new study (https://bit.ly/4erJamI) from Tufts University examined the accessibility and usability of hospital cost-estimate tools for common procedures. Although hospitals comply with transparency policies, the tools had only a 35.7% success rate for generating estimates. Much work remains to get accurate price data into the hands of patients. The American Bar Association reports (https://bit.ly/4hNp3Cr) that price transparency is reshaping price competition in US healthcare, with states taking measures as 17 states passing over 30 laws since 2020 for cost disclosures in hospital services. Despite ongoing challenges in translating transparency data into actionable information, state action on price transparency is needed. Aetna released a new plan called SimplePay Health (https://bit.ly/48Ojnnz) that seeks to simplify healthcare costs by eliminating deductibles, offering bundled billing, and providing a user-friendly app. The plan’s early results include a 60% increase in high-quality provider usage and 12% cost savings. Benefit design remains a significant opportunity for insurers to leverage price transparency data. 

Move your organization forward by getting a better understanding of Federally Qualified Health Center billing instructions. Register for this virtual event from FORVIS and Achieve Revenue Management to learn more.

Move your organization forward by getting a better understanding of Federally Qualified Health Center billing instructions. Register for this virtual event from FORVIS and Achieve Revenue Management to learn more.

QUAD A recognizes the indispensable role of Healthcare Documentation Specialists. During Healthcare Documentation Integrity (HDI) Week, we pay tribute to their meticulous approach to document review. Regardless of their location, these professionals serve an integral role in our healthcare system. They are the silent partners behind the scenes, double-checking that the quality and integrity of patient records are intact. Join us in recognizing their invaluable contributions to our healthcare system. #QUADA #HealthcareDocumentationIntegrityWeek #HDIWeek #PatientsFirst #GlobalAccreditation

Move your organization forward by getting a better understanding of Federally Qualified Health Center billing instructions. Register for this virtual event from FORVIS and Achieve Revenue Management to learn more.

Crack open the Christmas cracker. 🎅 This December, we’re launching a new series to spotlight the impact we’ve made across healthcare. Explore how we’ve shaped statutory and mandatory training below. 👇 #Impact #CSTF #StatutoryTraining #MandatoryTraining #SkillsForHealth

My FTI Consulting colleague Anne Winter shares her insights on increased accountability in Managed Care Programs and proposed amendments to regulations that will require more state oversight and reporting from the Plan. To implement these changes, the Centers for Medicare & Medicaid Services (CMS) is looking for people who understand the regulations, compliance, operational excellence, and can help them develop roadmaps in order to close those gaps in advance of the final rule. This is very important for Plans as they prepare for future procurements, because if they’re not performing today, they may not win in the future. Learn more:

ATT: HFMA MEMBER PROVIDERS, you don't want to miss this FREE webinar! This will be a perfect opportunity to learn what you need to know about the CFPB and it's new "proposed" rule which will make it more difficult for healthcare providers to collect patient balances of all types. (Provided by HFMA, sponsored by ACA International.)