Dennis Bierle

Interested in the CMS Medicare Shared Savings Program (MSSP), but not sure where to start? Check out this Sg2 expert blog post on how MSSP provides a structure for intentional strategic exploration and learnings, even for systems not fully committed to value-based care.

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Allowing Medicare to negotiate drug prices on behalf of older Americans remains broadly popular across partisans, though many voters are unaware of the new law and the billions of dollars it is expected to save in 2026, a new KFF Health Tracking Poll finds. A large majority (85%) of voters say they support allowing the federal government to negotiate the price of some prescription drugs for people with Medicare. This includes at least three quarters of Republican (77%), independent (89%) and Democratic (92%) voters. The Inflation Reduction Act of 2022 authorized such negotiations, and the Biden administration recently completed the first round of negotiations on 10 drugs, resulting in an estimated $1.5 billion in lower out-of-pocket costs for Medicare beneficiaries in 2026. #kff #medicare #prescriptiondrugs

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A February 2023 report from KFF estimated there were over 35 million prior authorization requests in 2021 • More than 2 million of these requests were denied by Medicare Advantage plan (MA) insurers, and just 11% of those were appealed ... ... 82% of the appeals resulted in an overturning of the initial prior authorization denial, highlighting the issue of inappropriate care denials. ✋ Stop the insanity! Toney Healthcare has you covered. Whether you need deep expertise to optimize your operations or staff to support your day-to-day UM activities our build a new line of business... 👍Our best in class UM experts can help you improve your operations and quality performance. #priorauthorization, #healthcare, #medicareadvantage, #healthcareoperations, #healthcareconsulting

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The latest National Hospital Flash Report highlights a concerning trend - the gap between high and low performing healthcare organizations is widening. Lower performing organizations often struggle to invest in key areas like strategic initiatives, employee retention, and facility enhancements. Is your organization looking to elevate its performance and drive positive change? Altius Healthcare Consulting Group offers leadership development, workforce optimization, and change management support to help you achieve your goals. Don't risk falling behind - take action today to propel your hospital or healthcare system to new heights of success. Reach out with a quick phone call or message to get started on your journey towards excellence. #HealthcareConsulting #LeadershipDevelopment #WorkforceOptimization #ChangeManagement https://lnkd.in/eZzvA2Ch

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🔍 Insights from a recent HFMA Region 8 panel, featuring experts Jana Danielson of Nebraska Medicine, Valarie Johnston, PhD, FACHE of Bryan Health, and veteran revenue cycle executive Ted S., MBA, FHFMA, EHRC, CELHP, moderated by Knowtion Health’s Sarah Loeffler. Top Takeaways: ✔ Anticipate Skill Gaps: Filling roles with deep expertise and institutional knowledge on denials teams can be challenging. Cross-training and rotating leadership roles, as done by Nebraska Medical Center, can offer new perspectives and strengthen your team’s capabilities. ✔ Adapt to A/R Dynamics: Traditional strategies may no longer suffice as payer behaviors and denial volumes evolve. Syverson emphasizes the importance of understanding A/R inventory to prioritize recovery opportunities, speed up resolution, and build effective front-end processes to prevent future issues. ✔ Leverage Denial Performance Data: Bryan Health’s focus on payer scorecards has enhanced their contracting and payer relations. Nebraska Medical Center uses the AHA’s Vitality Index to benchmark their denial metrics against peers, identifying areas for improvement. 💡 For additional insights, Loeffler shared research on goals and gaps in hospital denials processes, available in a recent study presented at Healthcare Financial Management Association (HFMA) ANI: https://lnkd.in/eJmPjqk3 #MASI2024 #HFMA #providerpanel #denials #AR #patientexperience #RevenueCycleManagement #research #insights

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Last year’s #Medicaid unwinding—which caused 16 million people (about the population of New York) to lose access to #healthcare coverage—has led the Centers for Medicare & Medicaid Services to issue a final rule to standardize the Medicaid enrollment and renewal process. This rule will make it easier for eligible individuals to maintain their coverage and provides additional consumer protections originally made possible by the Affordable Care Act. It’s encouraging to see adjustments being made to avoid another instance of children and adults unnecessarily losing #AccessToCare.

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Recent regulatory changes provide hospitals a unique opportunity to reassess their reimbursement practices and strategy, showing the value of completing three reporting types in tandem rather than one at a time. By understanding how reimbursement programs like Medicare DSH, Worksheet S-10 Uncompensated Care, and Medicare bad debts are related, hospitals can save time, alleviate strain on their IT departments, free up staff to focus on high-priority work, and potentially improve their financial health. Learn more in this Moss Adams article by Heather Keser, Jonathan Mason, Jesse Vo and Josh Stewart.

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🙌🏻 Good. Also if you need help renegotiating these types of agreements 👋🏻 We have over 1.5 million benchmarks (and growing), I would love to show you exactly how to save money on joint contracts.

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Here are five strategies for how healthcare providers can use claims, clinical data and benchmarking services to maximize their potential with payers.

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