As the aging population continues to shift into Medicare eligibility and toward Medicare Advantage programs, provider organizations are seeing their margins shrink to worrisome, unsustainable levels. For health systems, the time is now to pursue smart strategies for sustainability and growth. This was the main theme during an executive learning session at Becker’s 12th Annual…
Medical coding plays a vital role in healthcare, converting patient encounters into standardized codes used for billing, insurance claims, and performance tracking. Despite its behind-the-scenes nature, coding significantly impacts revenue cycles and regulatory compliance in healthcare organizations. With increased scrutiny from payers and government agencies, ensuring that medical coding practices align with current regulations has…
University Hospitals’ accountable care organization had a math problem: More than 64,000 diabetic patients and only a few endocrinologists. Besides the lack of available endocrinologists, there is a warped perception of who should care for the estimated 129 million Americans with at least one chronic disease, according to Peter Pronovost, MD, PhD. “Across America, the…
Clinical Documentation Improvement (CDI) programs play a vital role in Accountable Care Organizations (ACOs), ensuring accurate and comprehensive documentation that supports proper reimbursement, compliance, and quality patient care. With healthcare reimbursement models becoming increasingly complex, ACOs must implement strategies that streamline documentation, reduce errors, and align with Medicare’s risk adjustment models like Hierarchical Condition Category…
From AI-powered diagnostics to personalized medicine, we asked twenty four healthcare executives their insights on trends and technologies that will transform patient care in the coming year. In 2025, Artificial Intelligence and the T.E.A.M. (Transforming Episode-Based Accountable Management) model will redefine care coordination, creating a smarter, faster, and more equitable healthcare system. Primary care will…
A clear trend has emerged in the health care industry: Mergers and acquisitions of health care firms have slowed year over year. Though home-based care M&A showed “signs of life” in Q3 2024 in what has otherwise been a relatively quiet year thus far, transaction volume was still down last year, according to a report…
Healthcare organizations invest significant time, energy, and money into hiring physicians. But according to Douglas Farrago, MD, the author of ‘The Hospital Guide to Physician Retention,’ very few organizations invest adequate resources into keeping physicians. Farrago, a Family physician, became interested in the topic from his personal experience as an employed physician. “I wrote this book…
In October 2024, the Task Force turned 10 years old. In recognition of this anniversary, the Task Force released a two-part paper reflecting on the past 10 years of health care transformation and envisioning a path forward for the coming decade. The Task Force’s original vision and guiding principles remain sound today, providing a strong…
Accountable Care Organizations (ACOs) are designed to streamline patient care while optimizing healthcare costs and improving outcomes. However, one key aspect that many ACOs grapple with is ensuring accurate and compliant coding and billing practices. Coding and billing compliance are essential in preventing costly errors, minimizing revenue leakage, and maintaining regulatory adherence, which is vital…
In today’s complex healthcare system, the importance of accurate coding cannot be overstated, especially regarding Hierarchical Condition Categories (HCC) coding and Medicare risk adjustment. These components are vital in ensuring that healthcare providers are adequately reimbursed while complying with regulatory requirements. For organizations that handle Medicare Advantage patients, understanding and implementing accurate HCC coding practices…