Medicare and Medicaid

As CMS removes procedures from its Inpatient-Only (IPO) list, Allison Oakes, Trilliant's chief research officer, recommends that hospitals establish a clear outpatient strategy to avoid losing the income these procedures bring.

Revenue growth will come from clinical outcomes versus document mechanics, says Steve Mongelli, president at mPulse.

Janus Health's Carol Howard says the WISeR model's AI-driven reviews of specific Medicare services may trigger denials. To avoid this, hospitals must align clinical documentation with local and national coverage determination rules.

Jeff Ladner, Onspring's chief product officer, explains what healthcare leaders need to know about Medicare's six-year WISeR program, which will add new preauthorization requirements, documentation standards and appeals workflows.

Healthcare experts weigh in on how patients and providers will be impacted due to telehealth and hospital-at-home programs not being extended.

While shorter-term fixes like renegotiating payer contracts can help, Wipfli's Kelly Arduino recommends that hospitals heavily dependent on Medicaid rebuild community philanthropy and endowments.

Data reveals that the people who are enrolling in Medicare Advantage have 50% more chronic conditions than people who are enrolling in Medicare fee-for-service, says Christie Teigland, Inovalon's VP of research science and advanced analytics.

With healthcare spending, particularly for Medicare Advantage, under scrutiny, 1upHealth's Dr. Don Rucker says AI-ready, open API platforms that can integrate and analyze disparate data are needed to inform care and control costs.

Millie founder and CEO Anu Sharma discusses reasons why one-third of the U.S. is considered a "maternity care desert" and what can be done.  

The organization is seeking feedback on how to best advance digital health to empower seniors using technology, while reducing administrative burdens and improving interoperability.