Brief Primer for Medicare Appeals Process

by Phil C. Solomon July 19, 2016

Changes Proposed to Medicare Appeals Process July 13, 2016 Current Process Description – Every year, Medicare Administrative Contractors process an estimated 1.2 billion fee-for-service claims on behalf of the Centers for Medicare & Medicaid Services (CMS) for more than 33.9 million Medicare beneficiaries.  When beneficiaries or providers disagree with a coverage or payment decision made by […]

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CMS Plays The Wicked Witch of the West Due To Their Site-neutral Outpatient Payment Rule

by Phil C. Solomon July 18, 2016

Article is a 4-minute read CMS Becomes Arch Nemesis of Hospitals with Plans for Site-neutral Rates in Outpatient Payment Rule To hospitals, the Centers for Medicaid & Medicare Services (CMS) is acting like the terrible Wicked Witch of the West from the movie the Wizard of Oz because of their proposed plans for site-neutral rate […]

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Free Webinar: Uber-Up Your Patient Payment Liability Strategies

by Phil C. Solomon July 6, 2016

Free Webinar: Uber-Up Your Patient Payment Liability Strategies When: July 14, 2016 – 2:00 PM to 3 PM EDT Register: Sponsored by: The Georgia Chapter of HFMA __________________ Why Use The Uber Analogy to Reference Patient Payment Liability Strategies? Uber is an on-demand transportation service which has revolutionized the transportation industry. Uber’s new strategy reimagined the old […]

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Risk Adjustment and HCC Requirements – Another Pandora’s Box?

by Phil C. Solomon July 5, 2016

Risk Adjustment and the Hierarchical Condition Categories Methodology Risk Adjustment (RA) and Hierarchical Condition Category (HCC) coding is a payment model mandated by the Balanced Budget Act of 1997 (BBA) and implemented by the Centers for Medicare and Medicaid Services (CMS). The RA program allows CMS to pay plans for the risk of the beneficiaries […]

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Department of Health and Human Services OCR Scrutinizing BAAs

by Phil C. Solomon June 6, 2016

OCR Signals its Concern with Business Associates – BAAs The U.S. Department of Health and Human Services’ Office for Civil Rights (OCR) has lately been broadcasting its increased attention to, and concern about, HIPAA business associates on a monthly basis. In March, the OCR announced a $1.55 million settlement with North Memorial Health Care of […]

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LAST CHANCE to REGISTER for TOMORROW’S WEBINAR: Demystifying Revenue Cycle Best Practices

by Phil C. Solomon May 9, 2016

Free Webinar: Demystifying Revenue Cycle Best Practices To register: Demystifying Revenue Cycle Best Practices – May 12, 2016 11:00am to 12pm EDT Presenters: Lyman G. Sornberger – Chief Healthcare Strategy Officer Capio Partners Presenters: Lyman Sornberger joined Capio Partners in 2008 as their Chief Healthcare Strategy Officer. Prior to joining Capio and forming LGS Health […]

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Market vs. Medicine – by David Johnson – A Must Read Book About Affordable Healthcare

by Phil C. Solomon May 3, 2016

My colleague, David Johnson wrote this insightful book and I recommend it highly. Market vs. Medicine: America’s Epic Battle for Better, Affordable Healthcare is a must read for any healthcare business owner- large or small. Get your copy on May 9. Stay tuned for updates. – See more at: Learn about 4sight Health: 4sight Health […]

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MACRA and the Medicare Payment Reform Juggernaut

by Phil C. Solomon May 2, 2016

MACRA – More Changes Coming to Healthcare Delivery The passage of the Medicare Access and Children’s Health Insurance Program (CHIP) Reauthorization Act of 2015 (MACRA)1  has contributed to changes in healthcare delivery by redesigning Medicare’s payment and delivery methods for physicians and other clinicians. MACRA repealed the highly debated sustainable growth rate (SGR) formula which eliminates […]

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2016 Phase Two HIPAA Audit Program Update

by Phil C. Solomon April 29, 2016

The U.S. Department of Health & Human Services (HHS) Office for Civil Rights (OCR) announced the beginning of the 2016 Phase Two Health Insurance Portability and Accountability Act (HIPAA) Audit Program.  This program is designed to evaluate the compliance efforts of covered entities and their business associates (BA) with the HIPAA Privacy, Security and Breach […]

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Population Health – The Work Has Just Begun

by Phil C. Solomon March 30, 2016

Population Health’s Under Developed Capabilities  Despite remarkable medical advances, Americans are sicker today than ever.  With slow inevitability, individuals and society are accepting responsibility for improving our national health.  Addressing obesity and the chronic disease it spawns (see graphic) is America’s principal health challenge.  A  factsheet by the Partnership to Fight Chronic Disease details  scope […]

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Patient Satisfaction Delivered the Disney Way

by Phil C. Solomon March 3, 2016

Healthcare Can Learn A Lot from Disney About How to Satisfy Patients  Do you remember when you first discovered the magic of Disney? Whether you’re a child or adult, chances are the Disney experience changed the perception of how a consumer should be treated.  Disney follows three philosophical tenants to make sure they consistently deliver […]

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Telemedicine’s Impact on Value-based Care

by Phil C. Solomon March 1, 2016

Telemedicine arrangements that generate revenue, not just cost savings while improving patient care and satisfaction Value-based Care and telemedicine are key components in the health care industry as a way to generate additional revenue, cut costs and enhance patient satisfaction. One of the biggest changes to health care in the last decade, telemedicine is experiencing rapid […]

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