Annual Conference Day 3: UnitedHealth, Optum executives discuss resilience strategies for healthcare
Especially after being on the front lines of the most impactful cyberattack to hit the healthcare industry, leaders with UnitedHealth Group (UHG) and Optum have plenty of thoughts on how stakeholders can shore up their defenses. UHG is the parent company and Optum a sister company of Change Healthcare, which was the target of a…
The vital relationship between MDs and clinical documentation integrity
High-quality clinical documentation is vital for creating a complete picture of a patient’s health and medical history. Accurate records of diagnoses, medications, tests, treatments and other elements of a patient’s care are crucial in creating the most effective care plan leading to positive outcomes. The quality of a physician’s clinical documentation can also impact payer…
For providers, application of the 2-midnight rule to Medicare Advantage appears to bring a revenue influx
Hospitals appear to have gained a significant, albeit likely short-term, revenue boost from CMS’s 2023 directive to Medicare Advantage (MA) health plans regarding the two-midnight rule. The rule first was instituted in 2013 for Medicare fee-for-service (FFS), requiring the program to cover hospital stays as inpatient admissions if the admitting physician expects the stay to…
Hospital payments have been substantially affected by the Change Healthcare cyberattack, report finds
Newly published data reflect the extent of the payment loss experienced by hospitals and health systems during the first month or so after the Change Healthcare cyberattack. A report (registration required) published in mid-May by Strata finds that gaps in expected revenue ranged from 16.5% to 17.9% per hospital for Q1. The insights were culled…
Annual report on Medicare financing could reduce the immediate impetus to address longstanding issues
New data on the state of Medicare funding show short-term improvement while keeping the stakes high for ensuing decades. The annual report from Medicare’s trustees shows the Hospital Insurance Trust Fund (i.e., Medicare Part A) has enough money to keep beneficiaries covered and providers paid through 2036. That’s an increase of five years from the…
Closures of Walmart’s health centers reflect the widespread financial constraints in U.S. healthcare
Beyond signaling a setback for retail-based healthcare disruptors, Walmart’s recent decision to close its health centers is symptomatic of issues hampering the nation’s ecosystem for primary care, industry analysts say. The retail behemoth announced April 30 it would be closing all 51 of its health centers across five states, along with its virtual-health service. Five…
News Briefs: Hospital advocates bemoan the small Medicare payment increase proposed for FY25
The payment update described in Medicare’s FY25 proposed rule for inpatient hospital care and long-term care hospitals falls well short of what hospitals need to keep up with costs, advocates say. The inpatient payment rate would rise by 2.6% for hospitals that fulfill quality-reporting requirements and meet the criteria to be designated as meaningful users…
A year after Silicon Valley Bank’s collapse, what have we learned about managing counterparty risk?
On March 8, 2023, Silicon Valley Bank (SVB) announced a $1.8 billion loss from the sale of securities to cover a decline in clients’ deposits. The following day, SVB’s stock dropped 60% and the bank saw a historic $42 billion in withdrawal requests. Twenty-four hours later, SVB was under the control of U.S. banking regulators…
Insurers see reasons for concern as CMS keeps the Medicare Advantage purse strings tight for 2025
Medicare Advantage (MA) faces the prospect of constrained revenue and payments for participating stakeholders after CMS finalized what amounts to a small decrease in the 2025 payment rate. Average revenue for MA plans is projected to increase by 3.7%, or more than $16 billion — but that’s primarily because of a prospective increase in the…
News Briefs: Providers face trying times in the first month after the Change Healthcare cyberattack
Healthcare providers struggled financially and operationally in the first 30 days after a Feb. 21 cyberattack forced the shutdown of Change Healthcare’s claims submission and payment systems, among more than 100 other applications. As of the week of March 18, parent company UnitedHealth Group had restored Change Healthcare’s payment platform and was reporting progress in…