Payer or Competitor?
Admin by Tim Rowan, Editor Emeritus UnitedHealth Making Home Health Visits Payer or Competitor…that is the question. According to a report in the Wall Street Journal, and questioned by the insurance industry’s lobbying arm, AHIP, UnitedHealth Group has increased...Poor Joe is Out of A Job
CMS by Tim Rowan, Editor Emeritus We have been keeping an eye on the Medicare Advantage business as the number of beneficiaries who switch exceeds fifty percent. In past reports, we have described the federal lawsuits that accuse MA insurance companies of illicitly...The Wrong Way to Use AI in Healthcare
Admin by Tim Rowan, Editor Emeritus Lawsuits are beginning to pile up against insurance companies participating in the Medicare Advantage program. The complaint? The wrong way to use AI in healthcare is with faulty algorithms to approve or deny claims. While AI can be...HOPE is on the Way: Part 3
CMS By Beth Noyce, RN, BSJMC, BCHH-C, COQS CHAP-certified home health & hospice consultant This is part 3 of the 3 in the series, outlining the discussions and implications in adopting new outcome and process measures for Hospice care. The final segment addresses...CMS News: New Rule Cracks Down on Medicare Advantage Upcoding
CMS by Tim Rowan, Editor CMS Rule to Protect Medicare The U.S. Department of Health and Human Services, through the Centers for Medicare & Medicaid Services, finalized the policies for the Medicare Advantage “Risk Adjustment Data Validation” program, which...
