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FEBRUARY 1, 2023

What’s the good news for healthcare revenue cycle managers? Processing claims is one of the top contributors to wasted healthcare dollars in the U.S., Some Medicare Advantage plans are denying authorization for hospitalization. Claim denials are expected to keep increasing — both in terms of frequency and reasons.

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Healthcare Hospitals Medicare Clinic 10

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OCTOBER 20, 2021

innovations in behavioral healthcare?as Innovations in Behavioral Healthcare and the Path to Digital Transformation. A Case Study of Digital Transformation in Behavioral Healthcare. Paving the Way to Innovations in Behavioral Healthcare. Innovations in Behavioral Healthcare and the Path to Digital Transformation.

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Social Work Blog

NOVEMBER 4, 2022

The Center for Medicare and Medicaid Services (CMS) is seeking feedback from clinical social workers and other providers about how they should provide estimates for costs of services for patients who use their insurance to pay for health and mental health services.

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Medicare Medicaid Clinic Healthcare 85

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OCTOBER 7, 2021

Demand for home healthcare continues to rise, and at the same time home health aide staffing remains an ongoing challenge for agency administrators. Benefits of Healthcare at Home. Before COVID-19, the healthcare industry was already experiencing a shift in how our aging population wanted to receive care.

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JANUARY 11, 2023

For example, less than 20% of Medicare spending is currently value-based. But momentum will continue, since the Centers for Medicare and Medicaid Services (CMS) announced in 2021 that it plans to transition fully to value-based reimbursement by 2030. Healthcare organizations in the U.S. Why the change to value-based care?

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Medicare Healthcare Medicaid Hospitals 52

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NOVEMBER 4, 2021

Keeping an eye on your case mix is important with Medicare reimbursement shifting to value-based purchasing. The Centers for Medicare and Medicaid Services is planning to implement the Home Health Value-Based Purchasing (HHVBP) model nationwide in 2023. In 2020, PDGM changed reimbursement by focusing more on patient characteristics.

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Medicare Hospice Healthcare Medicaid 52

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JANUARY 30, 2024

Improving patient experience scores is a goal for many healthcare organizations — and for good reason. As they consider new ideas to raise patient satisfaction, healthcare leaders must have an understanding of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scoring system that evaluates these efforts.

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Healthcare Medicare Hospitals Clinic 52

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DECEMBER 8, 2022

But there is a particular educational tool that tends to fall under the radar of many healthcare organizations. Every year, the Centers for Medicare and Medicaid Services (CMS) releases the Program for Evaluating Payment Patterns Electronic Report (PEPPER). Medicare has identified 10 target areas as risky for proper payments.

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Medicare Hospice Rehabilitation Hospitals 52

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APRIL 18, 2025

In the ever-evolving world of healthcare, patient experience has emerged as a key indicator of quality care. From improving patient satisfaction to fostering trust, a focus on patient-centered care has become a necessity for healthcare organizations. In healthcare, the experience of the patient is the new marketing.

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DECEMBER 21, 2021

For Medicare claims, you already track care quality and report it to the Centers for Medicare and Medicaid Services (CMS). Those quality ratings appear on Medicare’s Care Compare website and inform prospective clients how well you’re achieving positive outcomes. Improve Your Quality Ratings. Market Your Successes.

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Medicare Hospitals Medicaid Healthcare 52

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APRIL 28, 2022

Revenue cycle management (RCM) is the financial process that makes it possible for most healthcare organizations to fulfill their mission of providing quality care for patients and communities. RCM is the set of functions that comprise the capture, management, and collection of patient service revenue in a healthcare organization.

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Clinic Healthcare Medicare Medicaid 52

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MAY 6, 2025

The good news is that, with the right processes and technologies, particularly for your overworked patient experience manager and staff, physician practices can supercharge their patient retention efforts and excel at healthcare reputation management to help mitigate costs. What are some costs physician practices face?

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Healthcare Administration Communication Medicare 40

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APRIL 18, 2022

Medicare payment models in skilled nursing and home health provide incentives for clinicians to be well versed in specialty areas such as skin and wound care. Chronic wounds affect about 15% of Medicare beneficiaries each year. Increase Reimbursements Based on Clinical Complexity. Build Your Reputation as a Specialist.

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Medicare Clinic Hospitals Medicaid 52

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SEPTEMBER 1, 2022

With the successes reaped during the pilot of the Home Health Value-Based Purchasing (HHVBP) program, the Centers for Medicare and Medicaid Services (CMS) aims to accelerate the results nationwide. The program started in 2016 as a pilot to determine the impact of financial incentives on home health agencies in nine states. million decrease.

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Medicare Hospitals Medicaid Healthcare 52

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MARCH 12, 2025

Regulatory drivers and competency standards Compliance with federal and state regulations is a top priority for healthcare organizations. Whether its skilled nursing facilities, hospitals, or home health agencies, regulatory bodies require that healthcare providers demonstrate competency in delivering patient care.

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Patient Safety Healthcare Medicare Clinic 40

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JULY 12, 2022

The speed of change in healthcare requires post-acute care organizations to take a different approach to job preparedness. By arming your care teams with the latest clinical and technical skills and world-class soft skills, you will better prepare them to adapt as needed to meet patients’ future healthcare needs.

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Hospice Healthcare Medicare Nursing Home 52

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DECEMBER 13, 2021

An unintended, but positive offshoot of the pandemic is that the crisis highlighted home health’s “very quick and successful adjustments” and “versatility” to serve COVID-19 patients and millions of others served under Medicare, Medicaid, Veterans Administration, and other services. Increased Compensation.

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Home Care Hospice Healthcare Medicare 52

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MARCH 5, 2025

With its rapid-acting benefits and potential to reduce suicidality, ketamine is becoming an increasingly important tool in behavioral healthcare. However, IV infusions must be administered by a healthcare professional due to the higher potency and rapid effects. Despite its effectiveness, ketamine therapy requires careful oversight.

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Patient Safety Medicare Treatment Planning Administration 40

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AUGUST 11, 2022

Analyzing the data allows providers to identify errors that may be occurring throughout the cycle and lower expenses from denials, incomplete claims, or healthcare fraud investigations. However, you also need quality reporting to monitor the ongoing health of your organization. Accurate Coding: The Most Important Piece of the Puzzle.

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Clinic Medicare Healthcare Administration 52

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JUNE 1, 2022

Coding and clinical documentation have never been more important in healthcare. “We At Sharp HealthCare, staff members were doing everything right — they used the correct codes, obtained authorizations, and scheduled services appropriately. Coding is high value — and in high demand. We are seeing sign-on bonuses. Downcoding by Payers.

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Clinic Justice and Corrections Medicare Healthcare 52

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JUNE 1, 2022

Coding and clinical documentation have never been more important in healthcare. “We At Sharp HealthCare, staff members were doing everything right — they used the correct codes, obtained authorizations, and scheduled services appropriately. Coding is high value — and in high demand. We are seeing sign-on bonuses. Downcoding by Payers.

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Clinic Justice and Corrections Medicare Healthcare 52

Relias

OCTOBER 28, 2022

Improved care quality and patient safety, reduced readmissions and ER visits, and lower healthcare costs are just some of the positive outcomes of effective care coordination. A well-designed care coordination process benefits patients, providers, and payer organizations. Increased scrutiny in hospices.

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Hospice Communication Clinic Patient Safety 52

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AUGUST 9, 2023

Tis the season for evaluating training programs and checking everything twice to make sure you’re on the Center for Medicare and Medicaid Services’ and The Joint Commission’s nice lists. One robust, magical platform “Platform” is something we hear quite often in IT, and it’s becoming ever more prevalent in healthcare.

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Engagement Healthcare Medicare Communication 52

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MAY 1, 2022

The Agency for Healthcare Research and Quality calculates that more than 17,000 lawsuits related to pressure injuries are filed each year — second only to wrongful death suits. Understanding the legal implications of gaps in care can help protect all involved: physicians, nurses, other caregivers, and healthcare administrators and leaders.

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Healthcare Hospitals Communication Medicare 98

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JANUARY 23, 2023

In our study, we noted that as few as 28% of women with PPD symptoms reported them to a healthcare provider. My colleagues and I work to help improve maternal health outcomes by providing the best education and competency evaluation solutions for the healthcare workforce. on referrals for behavioral health care.

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Depression Patient Safety Mental Health Medicare 98

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JUNE 19, 2023

According to a 2021 report from the United States Government Accountability Office, Medicare spending on stays for severe wound care declined about 2% from $2.06 According to the Agency for Healthcare Research and Quality , about 2.5 billion in fiscal year 2016 to $2.01 billion in fiscal year 2018. million people in the U.S.

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Healthcare Rehabilitation Medicare Hospitals 52

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OCTOBER 14, 2022

maternal mortality continues to increase despite the availability of world-class healthcare resources. Along with providing training and resources, they help midwives overcome the distrust of healthcare providers that often surfaces in marginalized populations. In the U.S., million U.S. Department of Health and Human Services.

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Telehealth Healthcare Hospitals Patient Safety 52

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OCTOBER 10, 2022

Federal and state agencies’ routine surveys of healthcare organizations can be stressful. With the Biden administration advocating for stricter scrutiny on nursing homes, we know inspection of healthcare facilities may increase even more. Regardless of the healthcare setting, you don’t want to be on this type of list.

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Nursing Home Healthcare Hospice Medicare 52

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FEBRUARY 26, 2024

According to the Agency for Healthcare Research and Quality (AHRQ), care coordination is “the deliberate organization of patient care activities between two or more participants (including the patient) involved in a patient’s care to facilitate the appropriate delivery of health care services.”

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Telehealth Healthcare Communication Hospitals 52

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JANUARY 16, 2023

A McKinsey & Company survey shows that up to $265 billion worth of care services could shift from traditional healthcare facilities to the home by 2025. Department and Human Services found that Medicare visits conducted through telehealth in 2020 increased 63-fold, from about 840,000 in 2019 to 52.7 Penalties rise to $1M.

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Healthcare Telehealth Medicare Nursing Home 52

Social Work Blog

DECEMBER 19, 2022

The Centers for Medicare and Medicaid Services (CMS) and advocacy organizations are providing guidance on ways to prepare individuals with Medicaid for the upcoming redetermination process. However, state agencies may have outdated contact information such as mailing and email addresses and phone numbers for recipients.

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Medicaid Advocacy Communication Social Worker 98

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MARCH 13, 2023

In the healthcare industry, regulations and best practices are always changing. The cost of healthcare in America is high, and the price for services can vary widely by region, a patient’s access to insurance, and even by insurance provider. Like other sectors of the economy, the healthcare industry has been affected by high inflation.

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Hospitals Medicare Healthcare Medicaid 52

Relias

JULY 14, 2023

Reducing the number of these deaths can be difficult due to social determinants that healthcare providers cannot easily control. More recently, the Centers for Medicare and Medicaid Services (CMS) issued its Maternity Care Action Plan , which also focuses on improving maternal health outcomes and advancing health equity.

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Clinic Mental Health Domestic Violence Healthcare 52

Relias

APRIL 6, 2022

New requirements from the Centers for Medicare and Medicaid Services (CMS) announced in November 2021 and a new time-limited enforcement effort by the Occupational Safety and Health Administration (OSHA) announced in March call for focused inspections and put a higher level of scrutiny on nursing home compliance and the quality of care provided.

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Nursing Home Medicare Medicaid Hospitals 52

Social Work Blog

FEBRUARY 3, 2025

During Kennedys confirmation hearing, he struggled to answer questions about Medicare and Medicaid, programs that affect tens of millions of Americans, or provide details about how he would work to drive down health care costs. NASW remains committed to policies that address systemic inequities in healthcare and social services.

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Human Services Medicaid Substance Abuse Medicare 91

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JULY 20, 2023

­The Centers for Medicare and Medicaid Services (CMS) issued a final rule in August 2022 to improve maternal health outcomes and advance health equity — two of the Biden-Harris Administration’s key priorities. But it’s also important to adopt a holistic view of the maternal healthcare experience. Sadly, U.S.

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Hospitals Medicaid Mental Health Medicare 40