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Navigating Medicare Advantage: Strategies for Hospitals to Tackle Growing Challenges

EvidenceCare

Written by Carol Howard, VP of Clinical Strategy As Medicare Advantage (MA) continues to grow, hospitals have faced growing challenges in navigating complex policies, payer friction, and financial pressures. These changes will impact how hospitals approach their contracts and denial strategies.

Hospital 130
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Health Insurers Take Major Accountability Step On Prior Authorization

Forbes Healthcare

Health insurers including Cigna, Aetna, Humana and Elevance Health are easing prior authorization, the process of insurers reviewing hospital admissions and medications.

Insurance 234
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Prior Authorization Is Changing

EvidenceCare

What Hospital UR & Revenue Cycle Teams Need to Know Written by Carol Howard, VP of Clinical Strategy A Brief History of Precertification Prior authorization (PA), originally known as precertification, began in the 1960s and expanded significantly during the rise of managed care in the 1990s. Kennedy, Jr.

Insurance 147
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Is A Health Unit Coordinator Job Hard?

We Care Online

Health Unit Coordinators perform crucial administrative functions in hospitals, clinics, and healthcare facilities, freeing up medical staff to spend more time with patients. Managing admissions, transfers and discharges. Common tasks include: Managing patient records. Arranging appointments for tests and procedures. Is the Job Hard?

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Reducing Clinical Variation: A Practical Guide for Health System Leaders

EvidenceCare

Behind every excess test, unnecessary admission, or prolonged length of stay lies a variation in practice—often unintentional, sometimes unavoidable, but frequently addressable. It can lead to unnecessary tests, treatments, admissions, and extended hospital stays , all of which inflate costs and introduce potential harm to patients.

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Engaging Physicians in Quality Improvement: Strategies for Driving Practice Change

EvidenceCare

When clinical teams embed learning into daily routines, reducing clinical variation becomes achievable and practice improvement in hospitals shifts from an initiative to a habit. Real-time dashboards can also flag length of stay variance, prompting collaboration to streamline processes and free up capacity for higher-acuity admissions.

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2025 Guide to Billing in Hospital Management Systems

Arkenea

trillion in annual transactions, yet billing inefficiencies cost hospitals an estimated $262 billion each year. At the heart of this challenge lies the complex world of billing in hospital management systems, where accuracy, compliance, and efficiency determine the financial viability of healthcare organizations worldwide.

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