The COVID-19 pandemic has changed the way people interact with each other, turning to video and other forms of social media to stay connected. This embrace of virtual technology has extended to medical care and has paved the way for what may very well result in permanent changes in the how health...

We can all agree COVID-19 brought about a seismic shift in the delivery of healthcare in 2020. This article reflects on services shifts, challenges those shifts create and approaches for providers and payers to anticipate and navigate the initiatives.Read More

CMS is planning to reduce mandatory bundles based on results, provider feedback and "minimum" utilization considerations. Some programs will be cancelled, some will not launch in 2018 and one is being scaled back. At the same time, we are helping our clients achieve great success building...

"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...

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...

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...

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...

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...

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...