“Looking for ways to reduce your post acute costs for the Mandatory CMS Joint replacement bundle? New products are entering the market that allow providers to gauge progress without onsite visits…in surprising ways. Microsoft Kinect shifts from gauging your dance moves to measuring your gait and recovery from hip or knee replacement. In addition, tracking and providing on demand rehabilitation therapy programs with instant feedback. Tell us what you think!Read More.

Reimbursement for telehealth services is much lower than non-telehealth care, according to a recent policy brief from the Health Care Cost Institute. Read More

Medicare Advantage Plans, need to update your strategy? Provider responsibilities and look back periods are reduced in the CMS final rule for overpayments. See more information:

The Centers for Medicare & Medicaid Services has issued a final rule regarding the legal requirements providers most follow if they are overpaid.

Medicare uncovers claims overpayments due to incorrect units of service and provider coding errors. CMS states Medicare contractors should collect their overpayments – how many outpatient overpayments are overlooked? Most focus on inpatient only. We can help!See More

Some Health Plans are charting new territory in population health management: Member centric clinical persona. In the traditional disease/condition categorization, many members were in separate and unconnected programs. The nine clinical personas are: healthy kids, healthy adults, acute kids and adults, ADD High-Cost/Rx, Serious Mental Illness/Substance Abuse/Other At-Risk, Uncoordinated Care, Chronic Coordinated, Complex Managed and Extreme Complex. We find the approach compelling. Read More.

Which “more specific” diagnosis/symptom/injury code is your favorite with the release of ICD-10 in October?

At Well Solutions Group, we picked “Pecked by a Chicken”, but “Bitten by a Cow” was a close second. Read More

Proposed Medicaid Managed Care Organization regulations include quality ratings for private plans providing benefits, in addition to provider network certification and member education. These changes are aligned with Medicare plan requirements, although well behind the rest of the CMS programs focused on quality of care while reducing overall costs. However, Medicaid reimbursement levels are lower posing larger challenges. Will quality measures be less robust? Read More.

The power of data to help personalize optimal treatment for cancer is exciting; yet even more exciting is the ability to prevent it. Even though the health care industry recognizes the risks to quality of life as well costs associated with a disease event, innovation and pro-active care will need to address proven/necessary treatment and the timing of the costs when health plan benefits are annual. Not only providers of care, but also employer groups, individuals, and multi-year government innovation will likely need to play the role of change agents.Read the story.

Increased diagnosis for first time insured individuals combined with convenience drug treatments are noted for a spike in costs around diabetes. At the same time, everyone agrees preventing complications is the real lever to reducing overall health care costs. The challenge continues: Insurance plans are renewed annually, yet the overall cost reduction is longer term. Is there an option to shift insurance plans from a 12 month cycle?. Read The Story.

Roughly a dozen mergers have taken place among health systems in Wisconsin in the past two years. Some have involved small rural hospitals, others large health systems.The mergers all have one thing in common: They were driven at least partly by the changes taking hold in health care. Read the Article