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There are 5 item(s) tagged with the keyword "Medicare".

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The Stars Impact of the CY2019 CMS Final Call Letter

Guest blog contributor:

Rex Wallace - Principal, Rex Wallace Consulting, LLC

On April 2nd, The Centers for Medicare and Medicaid Services (CMS) released the Announcement of Calendar Year (CY) 2019 Medicare Advantage Capitation Rates and Medicare Advantage and Part D Payment Policies and Final Call Letter. The entire document is a behemoth which includes important information about CY2019 for Medicare Advantage plans across a variety of topics. This paper will focus solely on the impact on Star Ratings.

The release of the Final Call Letter is one of a series of key milestone dates leading up to October 11, 2018, when CMS releases Star Ratings for each Medicare Advantage organization to the public.

Tags: Medicare, Medicaid, CMS, Final Call Letter, STAR, Statin, 2019 STAR, Rex Wallace, Star Rating, Medicare Advantage, HEDIS
Unexpected Unreasonable Claims Costs in Intraoperative Neurologic Monitoring (IONM)

Barbara Rutkowski, EdD, MSN, CCM - Vice President, Clinical Operations, Advanced Plan for Health & Joy McGee-Cory - Senior Vice President, Advanced Plan for Health

Several of our Health Plan clients and their members have experienced unexpected and very unpleasant surprises following certain complex surgical procedures – usually spine-related. So we wanted to get a cautionary word out a bit more broadly on this topic to our clients and others who may be facing similar situations. The surprises are coming in the way of bills for intraoperative neurologic monitoring (IONM).

In one case, the billing technician was not a physician, and the member’s bill for monitoring services was an unreasonable, non-negotiable $120,000.

Tags: Health Plan, Surgical Procedures, Healthcare Risks, Intraoperative Neurologic Monitoring, IONM, Out-Of-Network, Top Procedures, Medicare, Utilization
Benefits Pro: Kidney failure and dialysis: what employers need to know - by Joy McGee-Cory & Barbara Rutkowski

By Joy McGee-Cory & Barbara Rutkowski - Advanced Plan for Health

Published February 27, 2018

Chronic kidney disease is a health crisis that affects employer and employees—and it continues to increase. So, what can employers do to help their employees stay healthy and control their costs?

According to the National Kidney Foundation, “the annual Medicare spending to treat kidney failure in the U.S. is approximately $31 billion.”

Read more here

Joy McGee-Cory is Senior Vice President, Advanced Plan for Health & Barbara Rutkowski, EdD, MSN, CCM - is Vice President, Clinical Operations, Advanced Plan for Health

Tags: Chronic Kidney Disease, Dialysis, Kidney Failure, Healthcare Costs, Medicare, Benefits Pro
Important Trumpcare Topics and Comparison

Whether its Trumpcare or Obamacare – the name makes no difference when it comes to Population Health improvement. What the American people need is solidarity and a conscientious, diligent commitment to providing affordable healthcare to its citizenry. Citizens should in turn remain engaged and informed about the healthcare debate and how it might impacts their care. Below you will find important health reform information from Trumpcare.com, a site operated by HealthNetwork Group, an unbiased, consumer focused for-profit healthcare marketing company.

Tags: Donald Trump, Trumpcare, Obama, Obamacare, Health Insurance, Healthcare, ACA, American Healthcare, Affordable Care Act, Paul Ryan, House Speaker, Repeal and Replace, Bill, Votes, Law, Population Health, HealthNetwork, Pre-existing Conditions, Congress, Individual Mandate, Price Transparency, Insurance Premiums, Federal Tax Return, Interstate Insurance, Medicare, Medicaid, Fraud, Corruption
Barbara Rutkowski, EdD, MSN, CCM - Vice President, Clinical Operations

Dr. Rutkowski is a Medical Management Professional with more than twenty years of experience in operations, integrated medical management for Medicare and self-insured employers, hospital and managed care quality, and employee development.

Tags: Medical, Management, Professional, Integrated Medical Management, Medicare, Self-Insured, Employers, Hospitals, Managed Care Quality, Employee Development, Strategic Business, Health, Systems, Consulting, Organizational Development, Leadership, Team Building, Network, Risk, Clinical, Credentialing, Reinsurance, Regulatory Compliance, Wellness, Disease Management, Utilization, MedisGroups, Outcomes, Design, Development, Vice President, Nursing, University of Florida, Doctor, Education, Indiana University, Registered Nurse, American Journal of Nursing, Chamber of Commerce, Health Care Excel, Operations, Masters of Science

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