The APIs Are the Easy Part: Maximizing Your ROI while Meeting CMS Interoperability and Prior Authorization Requirementsy
Sponsored by
InterSystems
October 15, 2024
Health plans should be able to harness the investment in IT infrastructure mandated by the latest CMS rule on interoperability and prior authorization to create the data liquidity needed drive top strategic goals, such as reducing provider abrasion, improving member experience, increasing productivity, and supporting value-based care. The scope of CMS-0057-F, however, is wide ranging.
This white paper:
Summarizes new requirements for the four types of information sharing addressed, namely payer-to-payer, payer-to-provider, payer-to-member, and prior authorization submission and determination.
Analyzes processes and workflows impacted by the regulation and resulting opportunities for performance improvement.
Provides key “Questions to Consider” that should inform plan investment decisions.
Designed to be shared with IT, clinical, and operational leaders, the paper will help your leadership team achieve larger strategic returns on mandated plan investment while meeting regulatory requirements.
The latest report from Vizient on "Overcoming Capacity Constraints: Top Healthcare Leaders Share Their Strategies" explores the critical challenges healthcare systems face due to capacity constraints. These challenges are driven by factors such as tight financial margins, an aging population, a shrinking healthcare workforce and the closure of hospitals, which collectively increase the burden on emergency departments and inpatient care facilities.
You'll get expert advice from leaders at five well-known healthcare companies: Froedtert ThedaCare Health, Memorial Hermann Health System, NYU Langone, Sanford Health and UC San Diego Health. These leaders share their strategies for addressing these constraints, which include the adoption of advanced data analytics to enhance care delivery, strategic workforce management and the redesign of care delivery models to better meet patient needs.
For example, UC San Diego Health has introduced a geriatric-specific emergency department to cater to the unique needs of older patients. Similarly, Sanford Health has expanded its use of virtual care technologies to serve patients in rural areas more effectively. Another significant strategy discussed is the use of predictive analytics by Memorial Hermann Health System to identify high-risk areas for patient readmissions and to deploy targeted interventions to mitigate these risks.
This report also highlights the importance of addressing social determinants of health (SDOH) to tackle capacity issues more comprehensively. By focusing on these broader social factors, healthcare providers can implement more targeted and effective strategies to improve patient outcomes and manage capacity more efficiently.
This report underscores the need for proactive and data-driven approaches by healthcare leaders to navigate the complexities of capacity constraints and maintain high standards of patient care in a competitive healthcare environment.
The No Surprises Act: An Overview with Recommendations for Physician Practices
Sponsored by
Optum
October 3, 2024
Optum has been assessing the No Surprises Act (NSA) since late 2020 and has made necessary modifications to its billing policies and procedures to support compliance with the NSA provisions that took effect on Jan. 1, 2022. Our latest white paper provides physicians, billing staff, and others with a detailed summary of the law’s key requirements and mechanisms, as well as recommendations to help support compliance. Optum can help you understand the requirements and implement necessary changes to support your business practices.
Stay ahead of the curve, support compliance, and help protect your business from unexpected challenges associated with the No Surprises Act.
2024 Review of Physician and Advanced Practitioner Recruiting Incentives
Sponsored by
AMN Healthcare
September 30, 2024
An Overview of the Salaries, Bonuses, and Other Incentives Customarily Used to Recruit Physicians, Physician Assistants, Nurse Practitioners, and CRNAs
Understand what's key to recruiting and retaining physicians and APPs in today's rapidly evolving healthcare market.
Shaping the Future of AI in Revenue Cycle Management: Practical Applications for RCM Leaders
Sponsored by
R1
September 30, 2024
We understand that the healthcare industry has forever changed. It's not possible to manage today's healthcare with yesterday's technology - or yesterday's mindset.
Healthcare providers like you are increasingly engaged in an arms race with payers to leverage AI and automation for revenue cycle management.
Embracing these new tools is easier than you might think. Read on to learn more about practical applications for using AI and automation in your RCM.
More than ever before, healthcare providers need to strengthen their physician referrals. Having the right data can help foster and maintain physician relationships and drive strategic growth.
This e-book explores how to strengthen your physician referral strategy, with insights into how data and analytics can power efforts to retain patients through physicians. It includes:
How out-migration and referral leakage impact healthcare organizations
Ways to improve your physician relations strategy
Use cases that showcase how providers can use data insights to address referral challenges