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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. Document why you believe that. ” – Dr.

Hospital 130
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Preparing for CERT Audits and Practicing Compliant Documentation

EvidenceCare

This comprehensive guide provides hospital and revenue cycle leadership with vital insights on preparing for CERT audits and establishing processes for compliant documentation. This section delves into the specific criteria and expectations set by CERT audits, emphasizing the need for meticulous attention to detail and documentation accuracy.

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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. When clinicians privately see how their imaging rates, antibiotic choices, or LOS metrics stack up against trusted colleagues, the data becomes personal and motivating.

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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. Compliant documentation has also become more challenging. This highlights the necessity for hospitals to implement clear and robust compliance documentation practices.

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What do the Neighbourhood Health Guidelines mean for Practice Managers?

Practice Index

While the document sets out a vision for integrated, community-focused care, it provides little in the way of clear guidance for GP practices, leaving them uncertain about how they fit into the evolving system. The publication of the Neighbourhood Health Guidelines for 2025/26 has once again left general practice in the dark.

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HIPAA: Understanding Patient Confidentiality and How It Relates to Medical Assistants

Prism Career Institute

HIPAA is a law passed in 1996, mandating that all healthcare providers, health plans, and medical staff follow certain procedures to ensure patient privacy and safety. To maintain patient confidentiality, medical assistants are expected to secure electronic records and ensure physical documentation is not left unattended.

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Optimizing Revenue Cycle Management and Clinical Documentation Integrity To Avoid Coding Disasters

Relias

Coding and clinical documentation have never been more important in healthcare. “We We rely heavily on our coding quality team to onboard new coders and get them up to speed on our quality standards,” said Jake Hess, Senior Director of Revenue Cycle Shared Services at Spectrum Health. Undercoded Complex Hospital Admissions.