Ep 22 – Navigating Medicare Advantage Challenges for Hospitals – Live Panel

In this episode of The Better Care Podcast, EvidenceCare's VP of Clinical Strategy, Carol Howard, hosts a live panel of experts on regulatory updates and strategies for health systems related to Medicare Advantage and the two midnight rule to assure compliance and optimize revenue capture.Guests:Jackie Kimmell, Senior Director of Strategy Catalyst, The Health Management AcademyDr. Adam Fall, Corporate Medical Director of Utilization Management, Erlanger Health SystemDr. Jeny McNair, President and Chief Physician Advisor, Physician Advisory, Med-MetrixKey Takeaways:Medicare Advantage (MA) plans are set to grow significantly, prompting policy changes to control federal spending, such as the Version 28 HCC Model and adjustments to star ratings.Hospitals are encountering increased payer friction, with a significant rise in MA denials and a need for robust strategies to manage Medicare patient classifications.Proper documentation and understanding of payer rules, including the CMS two midnight rule, are paramount to minimizing administrative burdens and ensuring appropriate reimbursements.The importance of contract negotiations, advocating for shorter contract terms and clear terms regarding the use of AI in care management.The potential impact of the Chevron ruling on medical necessity appeals could lead to significant legal and operational shifts in how hospitals manage and appeal payer decisions.---The Better Care Podcast is produced by EvidenceCare.Sign up for email updates when new episodes are released.---Follow EvidenceCare:LinkedInX