Risk adjustment requires constant attention to ensure accurate coding, timely regulatory compliance, and streamlined communications across the payer-provider continuum. Increasingly rigorous oversight from the Centers for Medicare & Medicaid Services (CMS) and Office of the Inspector General (OIG) are calling for better diligence, planning and administrative oversight for effective risk adjustment.
The January 2023 rule from CMS, which struck the fee-for-service adjuster from risk
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Cloud Development Environments: A New Frontline in Healthcare Cybersecurity
It’s no surprise that one of healthcare leaders’ biggest fears is having customer data stolen, leaked or exposed. As large healthcare breaches hit record highs, hacks are affecting more individual records than ever – 136 million in 2023, more than double the previous year. This has triggered a wave of class action lawsuits, disruptions in billing cycles, and major service impacts at healthcare institutions.
Given this backdrop, healthcare organizations are doing everything they can to keep
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How GenAI Solves for Challenges in the Healthcare Front Office
While in recent years healthcare has made significant strides toward optimizing the customer experience, the industry is now at an inflection point with the adoption of generative AI (GenAI). With its highly trained and expensive talent and mountains of unstructured data, healthcare is uniquely suited to leverage GenAI to drive productivity and an improved consumer and employee experience. In fact, according to McKinsey, healthcare companies could unlock up to $1 trillion in value by
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How Next-Gen Sleep Monitoring Can Help Children and Adolescents Achieve Academic Success
It’s no secret that sleep is crucial for children's health and academic performance. A good night's rest enhances cognitive functions like memory and problem-solving, which are vital for learning and test performance. Aside from academic performance, adequate sleep promotes a myriad of different physical and emotional benefits, including stress management, a more positive outlook on life, proper growth, immune function, and much more.
Despite the endless benefits, some students
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UPGRADEing Healthcare: Empowering Caretakers with Top-Tier Cybersecurity Readiness
Billions in payments disrupted. Patient care stalled. Personal data of one in three Americans exposed. The February ransomware attack on Change Healthcare, a UnitedHealth subsidiary, didn’t just shake the industry—it shattered it. It shouldn’t take massive breaches to highlight the glaring need for better cybersecurity in healthcare, but unfortunately here we are. In response, the White House is now stepping in, commiting over $50 million for the UPGRADE Program. This landmark initiative
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The Good, the Bad, the Ugly When Leveraging AI in Healthcare
Much has been discussed about artificial intelligence (AI) and the impressive proliferation of Generative AI (GenAI) over the last several months. It is staggering. As I think about the potential changes and impacts of leveraging AI and GenAI within a healthcare organization, I can’t help but think about the good, the bad, and the ugly.
Good: Ambient AI
There are many positive examples so far, where AI can improve healthcare, but one stands out for me: ambient AI technology. It’s a
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Beyond FHIR: AI’s Potential to Revolutionize Healthcare Data Insights
For decades, one of the most daunting tasks in healthcare has been managing and making sense of the vast amounts of data generated annually. From patient and outcomes data to billing and scheduling data, the list goes on and on.
The predominant challenge lies not just in quantity but like this data: much if not most of it is unstructured, i.e., data that isn’t predefined and searchable on a table, such as text messages, images, videos, audio files, and emails.
Historically, healthcare
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How to Implement Remote Therapeutic Monitoring with Success
Implementing remote therapeutic monitoring (RTM) successfully holds the key to revolutionizing healthcare delivery, enhancing patient outcomes and care efficiency. RTM leverages digital health technologies to monitor patients' conditions and adherence to treatment plans in real time, facilitating timely interventions and personalized care. This innovative approach not only empowers patients by providing them with continuous support but also allows healthcare providers to make data-driven
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From Chaos to Calm: How ER Scheduling Could Help Fix Emergency Care Challenges
Staffing shortages and rising costs leave ERs in chaos and even force some hospitals to shut down money-losing emergency departments altogether. Chaotic or closed emergency rooms not only cost lives but cut off a pipeline of new patients that provide income for hospitals and jobs for specialist physicians.
The main driver behind ER chaos and expense is a nationwide shortage of trained doctors and nurses. A single nurse often has to care for ten or more patients in the ED simultaneously,
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Moving Nurse Leaders from Task Managers to Business Leaders
As a CNO of more than 20 years, I have observed the nurse manager role evolve from what we would typically think of now as a charge nurse to that of essentially serving as the CEO of a multi-million-dollar enterprise. Nurse managers are responsible not only for clinical quality and patient satisfaction, but also for financial performance, employee engagement, operational efficiency, accreditation, regulatory standard compliance, and more. They are the linchpins to achieving hospitals’ strategic
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