Medicare and Medicaid

Dr. Christopher R. Cogle, director of the Florida Health Policy Leadership Academy, says designing systems for the most complex and vulnerable populations has created advances for healthcare information technology.

As CMS deploys AI tools and data analysis to uncover possible Medicare and Medicaid fraud, COO Kimberly Brandt explains that suspected providers are offered education on billing rules and three chances to correct any errors.

According to CMS' Amy Gleason, the agency is inspiring innovation by offering vendors the opportunity to develop secure, CARIN code-certified patient-facing apps. These apps will be made available via the Medicare.gov website.

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.