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American Medical Association (AMA) reported that is has published the first major overhaul in more than 25 years to the codes and guidelines for office and other outpatient evaluation and management (E/M) services in the release of the 2021 Current Procedural Terminology (CPT) code set. These foundational modifications were designed to make E/M office visit coding and documentation simpler and […]
Read MoreThe proposed rule significantly changes payer value-based payment negotiations, allowing for more long term value-based contracting. CMS has proposed a rule that allows payers to adopt new value-based payment models for gene therapies. CMS’s rules for ensuring that Medicaid receives the lowest price available for prescription drugs have not been updated in thirty years and are blocking […]
Read MoreThe Aetna Whole Health plan aims to provide employers fully-insured and self-insured plan options with ACOs and upside risk contracts. Aetna Whole Health plans to offer employers access to self-insured and fully-insured plan options that focus on better care coordination through accountable care organizations (ACOs) and incorporating upside risk value-based contracting. Aetna Whole Health partners with accountable […]
Read MoreHealthcare can be confusing, especially when trends change rapidly with advancements in science and technology and government regulations. Value-Based Care: In a value-based system, providers, hospitals, and physicians are paid based on their patient’s health outcomes, rather than how many patients they see or how many hours they log. Health outcomes are measured in factors […]
Read MoreHow to act like a respected leader? Not sharing how we’ve failed (and talking up our accomplishments too much) triggers something decidedly not good in peers. This envy creates dysfunctional behavior as peers, or even direct reports, seek to tear down and undermine the successful leader. It also causes employees to behave less and disrupts […]
Read MoreWhen planning your career growth in healthcare, you’ve likely considered the best education options. The skill set you learn to work as a physician, nurse, or any type of support staff in healthcare is understandably a high priority. We often spend so much time considering the type of training and level of references we need […]
Read MoreWhat is a Medicare Advantage plan? If you are under the original Medicare (Part A and Part B), you might have an option to get your Medicare coverage in another way through a Medicare Advantage plan, offered by Medicare-approved private companies. Medicare Advantage plans must cover everything federal Medicare covers except for Hospice care which […]
Read MoreEvaluating a specific value-based contract requires weighing the potential benefits and risks related to the organization’s capabilities and resources, the financial impact, and credit risk. Physician engagement, transparency and accountability, and performance measurement and improvement all must be in place for a value-based contract to be successfully implemented. We provide the expertise and in-depth understanding […]
Read MoreI believe that only about one-fifth of doctors have recently started providing ancillary services. But as the squeeze on physicians’ reimbursements continues, interest in ancillary services has been increasing and interest varies widely by specialty. PCPs, in particular, have a wide range of ancillary services to choose from. Family physicians listed medication dispensing, weight-loss services, […]
Read MoreWhat is managed care contracting? Managed care contracting are contracts which attempt to restrain healthcare costs by controlling both the quality and the type of services provided. The level of service and cost are both considered with managed care contracting. There are three basic types of managed care health insurance plans: (1) HMOs, (2) POS […]
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