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Navigating Medicare Advantage: Strategies for Hospitals to Tackle Growing Challenges

EvidenceCare

CMS Policy Changes to Reduce Costs Financial pressures are rising as CMS implements the updated Version 28 Hierarchical Condition Category (HCC) model , which introduces changes aimed at limiting types of codes that are most used for up-coding or over-coding to help rein in spending. MA plans are looking for contradictions in provider notes.

Hospital 130
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Engaging Physicians in Quality Improvement: Strategies for Driving Practice Change

EvidenceCare

Real-time dashboards can also flag length of stay variance, prompting collaboration to streamline processes and free up capacity for higher-acuity admissions. Targeted clinical decision support , such as focusing on same-day discharge rates for low-risk patients, can increase evidence-aligned discharges and reduce readmissions.

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AI is Transforming Healthcare Behind the Scenes

Mobius MD

Having AI check errors gives providers peace of mind while speeding up reimbursements and minimizing costly denials. By predicting admissions and discharge patterns, AI helps prevent overcrowding and reduces wait times. These tools optimize appointment slots to reduce schedule gaps and keep clinics running smoothly.

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How BPCI Enhances Patient Experience and Lowers Costs: A Comprehensive Guide

Guideway Care

Advancing these efforts, the BPCI Advanced model introduces a consolidated retrospective payment system that addresses services within a 90-day period following discharge or outpatient procedures. These particular models concentrate on consolidating payments for all services provided during an episode of care into one bundled payment.

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A ‘SEET’ at the Table: Managing the Four Drivers of Patient Experience

Walker Info - Patient Experience

The following steps outline how healthcare providers can implement the four key PX dimensions. How much faith do you have in our ability to deliver the quality care you need? Putting the Four PX Dimensions to Work Elevating PX takes time and a willingness to see things through the eyes of the patient.

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New Insights on Medicare Advantage Plans and The Two-Midnight Rule

EvidenceCare

This also means that the medical record must support the reasonableness of the clinician’s admission decision regardless of the total time spent in the facility. We’re still facing the same types of denials, especially with short stays where payers push back post-discharge.” Another issue is “inpatient only” procedures.

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Preparing for CERT Audits and Practicing Compliant Documentation

EvidenceCare

From understanding the audit requirements to implementing technology for streamlined admission documentation , this article offers actionable strategies to ensure hospitals are well-prepared for the rigorous evaluation process. Think of your documentation as the ironclad defense for your hospital admissions. As researched by OS Inc.,